UT HB0527

Pharmacy benefit managers (PBMs) must provide network pharmacies with electronic, searchable lists identifying all drugs with maximum allowable costs, including the national drug code and maximum allowable cost for each drug

When denying a pharmacy's appeal of maximum allowable cost reimbursement, PBMs must now provide the specific basis showing the drug is available for purchase at or below the maximum allowable cost

If an appeal is upheld or the PBM cannot demonstrate drug availability at the stated price, the PBM must adjust payment for the appealing pharmacy and allow claim reversal and resubmission without additional charges

Violations carry penalties of up to $2,500 per day, with each day of continued violation counted as a separate offense

Effective date: May 6, 2026