H.B. 336 Summary

• Imposes strict requirements on pharmacy audits by auditing entities, including 10 business days' notice before on-site audits, limiting audits to 250 prescriptions or fewer, prohibiting use of extrapolation for penalties, and requiring clear documentation of errors before recoupment.

• Prohibits health plan issuers from directing covered persons to affiliated pharmacies, restricting pharmacy choice, imposing differential cost-sharing based on pharmacy selection, and sharing prescription data for commercial purposes.

• Requires health plan issuers and Medicaid managed care organizations to ensure orally administered cancer drugs are available within 72 hours of clean claim submission, with coverage at out-of-network pharmacies if in-network options cannot meet the deadline.

• Regulates pharmacy reimbursement incentive payment systems by requiring contracts six months in advance, basing evaluations on actual pharmacy performance data (not extrapolation), using objective standards, and matching any payment decreases with equal potential increases.

• Allows covered persons and pharmacies to bring civil actions for compensatory damages and injunctive relief against health plan issuers and Medicaid managed care organizations for violations of these provisions.