House Bill 1612 Summary

• Prohibits pharmacy benefit managers (PBMs) from charging plan sponsors more for prescription drugs than the net amount paid to pharmacies, and voids any contracts violating this requirement.

• Requires PBMs to provide pharmacies a reasonable administrative appeal procedure (with 45-day filing period and response timeline) to challenge reimbursement rates as below pharmacy acquisition cost, and prohibits patient copayments exceeding total PBM reimbursement to the pharmacy.

• Prohibits PBMs and affiliates from ordering patients to use affiliate pharmacies, penalizing patients for not using affiliates, or interfering with patient choice of pharmacy or provider.

• Creates new anti-retaliation protections preventing PBMs from terminating contracts, increasing audit frequency, or delaying payments against pharmacists or pharmacies exercising rights under the law or participating in legal/regulatory proceedings.

• Grants the Department of Insurance authority to conduct examinations and issue subpoenas to investigate PBM compliance, with examination costs paid by non-compliant PBMs deposited into a special fund for board operations regulating PBMs.