PA SB1186

Department of Human Services must select and contract with a single State pharmacy benefits manager by July 31, 2026 to administer all pharmacy benefits for Pennsylvania Medicaid recipients, including those enrolled in managed care organizations

State PBM is prohibited from using spread pricing, requiring enrollees to use mail-order or PBM-affiliated pharmacies, retroactively denying valid claims, and charging pharmacies direct or indirect remuneration fees or other transaction fees

Pharmacy reimbursement rates must be no less than National Average Drug Acquisition Cost (or wholesale acquisition cost if unavailable) plus a professional dispensing fee set at 100% of the Medicaid fee-for-service rate based on in-state surveys conducted every three years

Pass-through pricing is required, meaning the PBM must charge the health plan the same price for a drug that it pays to the pharmacy

Applicants must disclose potential conflicts of interest including common ownership with managed care organizations, pharmacies, drug wholesalers, or third-party payers, and financial arrangements with drug manufacturers