MS HB1298

Requires pharmacy benefit managers (PBMs) to use the national average drug acquisition cost (NADAC) when determining reimbursement for the ingredient drug product component of pharmacy services.

Prohibits PBMs from reimbursing pharmacies or pharmacists less than NADAC; if NADAC is unavailable, PBMs must reimburse at least the wholesale acquisition cost as defined in federal law.

Establishes requirements for maximum allowable cost lists, including timely updates (within 3 calendar days), pharmacy access to lists, and administrative appeal procedures for pharmacies to challenge reimbursement rates.

Requires PBMs to obtain licenses from the State Board of Pharmacy, file annual financial statements, and prohibits retroactive denial or reduction of adjudicated claims.

Effective July 1, 2023; brings forward existing provisions of the Pharmacy Benefit Prompt Pay Act and accident and health insurance regulations.