Signed by Governor Kay Ivey

Vote Smart's Synopsis:

Vote to pass a bill that would establish new regulations on reimbursements and fees that pharmacy benefit managers charge to pharmacies.

Highlights:

• Establishes new restrictions on Pharmacy Benefit Managers (PBMs) including (Sec. 1-5):

• A prohibition on reimbursing independent pharmacies at rates lower than those paid by the Alabama Medicaid Agency;

• Ban PBMs from charging certain fees to pharmacies;

• Require PBMs to pass on 100% of manufacturer rebates to health plans; and 

• Prevent them from blocking pharmacists from disclosing lower-cost alternatives to patients.

• Prohibits PBMs from directly, or through an affiliate or a contracted third party from (Sec. 3):

• Reimburse for dispensing a prescription drug in an amount that is less than the Medicaid reimbursement rate;

• Impose a fee or otherwise adjust or lower the reimbursement of a drug at the time the claim is adjudicated, or after the claim is adjudicated, that in any way reduces the amount of reimbursement for the drug as regulated;

• Increase a covered individual's cost-sharing percentage or ratio at or after the point of sale by raising the deductible, copayment, or coinsurance, or by requiring any other out-of-pocket payment as a means to recoup the dispensing cost portion of the reimbursement required; or

• Reject payment of a claim for a drug that is submitted by an independent pharmacy when the drug is available to a covered individual at a different in-network pharmacy.

• Specifies that the provisions of this bill shall take effect immediately upon passage and approval by the Governor, except for section 3 which shall not take effect until October 1, 2025 (Sec. 6).

Full Bill Text