Pharmacy Benefits Manager regulation; to substitute "unaffiliated" pharmacy for "independent" pharmacy
SB345 revises Alabama’s pharmacy benefits manager (PBM) law by replacing the term “independent pharmacy” with “unaffiliated pharmacy” throughout the relevant statutes. Under the bill, an unaffiliated pharmacy is defined as a pharmacy that is not a PBM affiliate, rather than a pharmacy classified by the Alabama State Board of Pharmacy as a community pharmacy. The bill makes conforming changes to definitions and cross-references in the PBM regulatory chapter, including provisions governing reimbursement, network participation, spread pricing, steering, rebates, specialty drugs, and related pharmacy practices.
The bill also updates the section that sets special reimbursement protections for these pharmacies. It requires PBMs to reimburse unaffiliated pharmacies at no less than the Medicaid reimbursement rate, prohibits retroactive fees or other reimbursement reductions that would undercut that floor, bars certain cost-sharing increases used to recoup dispensing costs, and limits claim denials when a drug is available at another in-network pharmacy. A public-employee health plan may be exempt if it reimburses above the statutory rate and proves that to the commissioner. The act would take effect June 1, 2026.
SB345 would amend Sections 27-45A-3, 27-45A-10, and 27-45A-13 of the Code of Alabama 1975, as enacted in Act 2025-136, primarily by changing statutory terminology from “independent pharmacy” to “unaffiliated pharmacy” and aligning the rest of the PBM chapter with that new term. The practical effect is to preserve and clarify the class of pharmacies protected by the law while redefining that class by relationship to PBMs rather than by Board of Pharmacy classification. The bill continues to regulate PBM reimbursement practices, network access, audit-related fees, steering, spread pricing, and other conduct affecting pharmacies, pharmacists, health benefit plans, and covered individuals.
The available context shows no recorded committee debate or floor votes, so there is no documented opposition or support in the provided materials. Based on the bill text, the measure appears to be a technical and clarifying update to an existing PBM reform law rather than a major policy reversal. Its overall posture is pro-pharmacy and pro-regulation of PBM practices, suggesting likely support from independent community pharmacy interests and scrutiny from PBMs and health plan stakeholders.
The main point of contention is likely the scope and effect of the PBM restrictions, especially the reimbursement floor tied to Medicaid rates, the limits on spread pricing and retroactive fees, and the prohibition on steering or excluding pharmacies from networks. PBMs and health insurers may object to the bill’s constraints on contracting, pricing, and network design, while pharmacies are likely to support the protections. A secondary issue is the terminology change itself: replacing “independent pharmacy” with “unaffiliated pharmacy” broadens or clarifies the protected category by focusing on PBM affiliation rather than state board classification, which may affect which pharmacies qualify for the statute’s protections.