House Bill 1593 Summary

• Expands definitions of pharmacy benefit managers, pharmacy benefit management services, and related terms; creates new definitions including "payment remittance advice," "pharmacy services administrative organization," and "wholesale acquisition cost."

• Requires pharmacy benefit managers to provide reasonable administrative appeal procedures allowing pharmacies to challenge reimbursement rates as below acquisition cost, with responses required within 30 business days and remedies including rate adjustments and claim reversal/rebilling.

• Prohibits pharmacy benefit managers from charging plan sponsors more than the net amount paid to pharmacies (excluding separately agreed administrative fees) and from charging patients copayments exceeding total reimbursement paid to pharmacies.

• Prohibits pharmacy benefit managers from requiring patients to use affiliated pharmacies or penalizing patients for choosing non-affiliated pharmacies; creates new anti-retaliation protections for pharmacists and pharmacies exercising rights under the act.

• Expands State Board of Pharmacy authority to conduct audits and examinations of pharmacy benefit managers, issue subpoenas for relevant documents, assess monetary penalties up to $25,000 per violation, and hire independent consultants for appeal audits with costs paid by the pharmacy benefit manager being audited.