Insurance, Health, Accident - As introduced, prohibits a pharmacy benefits manager from reimbursing a contracted pharmacy for a prescription drug or device or a pharmacy service in an amount that is less than the greatest of certain listed amounts and makes other related changes. - Amends TCA Title 8, Chapter 27; Title 56, Chapter 7 and Title 71, Chapter 5.
Taken off notice for cal in s/c Insurance Subcommittee of Insurance Committee
Summary
The measure bars PBMs from paying contracted pharmacies for drugs, devices, or services at amounts lower than the highest of four benchmarks: the pharmacy’s actual cost, 105 % of the national average drug acquisition cost, the wholesale acquisition cost when NADAC isn’t available, or the PBM’s own reimbursement rate. It creates a formal appeal process, requires prompt payment, and doubles any shortfall as a penalty. The aim is to protect pharmacy revenues and promote fair pricing.
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