H.B. 63 Summary

• Prohibits health plan issuers, pharmacy benefit managers, and administrators from requiring patient cost-sharing greater than the lesser of the drug's uninsured cash price or the net reimbursement paid to the pharmacy.

• Requires pharmacists, pharmacy interns, and terminal distributors to inform patients when their health plan's cost-sharing amount exceeds the amount otherwise chargeable for the same drug, and prohibits charging the higher amount.

• Restricts retroactive pharmacy claim adjustments to those resulting from pharmacy audits conducted in accordance with state law or technical billing errors.

• Prohibits charging claim-related fees unless the fee amount can be determined at the time of claim adjudication.

• Directs the Department of Insurance to create a web form for consumers to submit complaints regarding violations of these pharmacy pricing provisions.