Senate Bill 1151 Summary

• Establishes the "Pharmacy Benefit Management Act" requiring pharmacy benefit managers to obtain annual certificates of authority from the Department of Insurance and Financial Services, with filing fees of $200 for initial application and $25 for annual renewal.

• Mandates that pharmacy benefit managers use transparent, consistent prescription drug pricing standards updated at least weekly, provide written appeals processes for pricing disputes with 21-day appeal limits and 10-business-day resolution requirements.

• Prohibits pharmacy benefit managers from mandating use of affiliated pharmacies, incentivizing only affiliated pharmacies, requiring network participation as a condition of participation in other networks, automatically enrolling/disenrolling pharmacies without written consent, or imposing differential copayments between network and mail-order pharmacies.

• Establishes detailed pharmacy audit standards including 2-week advance notice requirements, limitations on audit scope to 1-year period, prohibitions on extrapolation audits and percentage-based audit recoveries, 60-day preliminary report deadlines, 30-day dispute periods, and exemption of clerical errors from fraud penalties absent proof of intent.

• Requires pharmacy networks to include sufficient pharmacies within 30 miles of covered individuals and allow out-of-network pharmacies closer to patients to be designated as primary pharmacies with in-network benefits; takes effect 90 days after enactment.