SB93 would significantly expand Alabama’s regulation of pharmacy benefits managers (PBMs) and their relationships with pharmacies, pharmacists, covered individuals, and health benefit plans. The bill amends the existing Alabama Pharmacy Benefits Manager Licensure and Regulation Act to define and restrict PBM practices, including prohibiting reimbursement below a pharmacy’s actual acquisition cost plus a professional dispensing fee, banning spread pricing, and barring a range of network, credentialing, and administrative fees charged to pharmacies. It also limits PBM conduct toward consumers by protecting pharmacy choice, restricting steering to mail-order or PBM-affiliated pharmacies, and allowing pharmacists to disclose drug price and alternative-drug information to patients.
The bill further creates a new Section 27-45A-13 that requires PBMs to include a dispensing fee in reimbursement and allows a pharmacy to refuse to dispense a drug if reimbursement is below its dispensing cost, without retaliation from the PBM. It also authorizes pharmacies to disclose reimbursement rates to ultimate payors, subject to privacy law. In addition, SB93 expands enforcement authority for the Commissioner of Insurance over PBM-related violations and pharmacy audits, including authority to investigate complaints involving auditing entities licensed or regulated under Title 27 and to enforce the Pharmacy Audit Integrity Act.
In practical terms, the bill would affect PBMs, pharmacies, pharmacists, insurers, payors, and covered individuals by changing reimbursement rules, limiting PBM leverage over pharmacy networks, and strengthening pharmacy audit protections. It also references federal programs and carve-outs, including exclusions for specialty drugs and certain ERISA self-funded plans, and it preserves federal-law consistency where applicable. The bill would amend multiple sections of the Code of Alabama 1975 and take effect on October 1, 2025.
The overall sentiment reflected in the bill text is strongly protective of pharmacies and consumers, with the legislation framed as a response to PBM reimbursement practices, fees, and audit-related pressures. No committee transcript or vote record is provided, so there is no recorded debate or roll-call evidence of opposition or support in the supplied materials. Based on the bill’s structure, its sponsors, and its committee referral to Banking and Insurance, the measure appears to be aimed at addressing concerns about PBM market power and pharmacy viability.
The main points of contention likely center on whether the bill’s reimbursement mandates, fee prohibitions, and anti-retaliation rules would increase costs or reduce flexibility for PBMs and health plans, versus whether they are necessary to prevent underpayment and unfair practices affecting local pharmacies. Another likely issue is the scope of the Commissioner of Insurance’s enforcement authority and the interaction with federal law, ERISA plans, and specialty-drug or Medicaid-related carve-outs.
SB93 would amend Sections 27-45A-3, 27-45A-6, 27-45A-7, 27-45A-8, 27-45A-10, 34-23-181, 34-23-185, and 34-23-187 of the Code of Alabama 1975 and add new Sections 27-45A-13 and 34-23-188. It would impose new reimbursement floors and fee restrictions on PBMs, prohibit spread pricing, protect pharmacy participation and consumer choice, and expand the Commissioner of Insurance’s enforcement role over PBM conduct and pharmacy audits. The bill would also create new rights for pharmacies to refuse under-reimbursed dispensing and to disclose reimbursement information to ultimate payors, while preserving certain federal-law exceptions and excluding specialty drugs and some self-funded ERISA plans from parts of the chapter.
The bill’s tone is generally pro-pharmacy and pro-consumer, reflecting a legislative effort to curb PBM practices viewed as harmful to independent pharmacies and patient access. Because no committee transcript or vote history is included, there is no direct record of debate, amendments, or formal support/opposition in the supplied materials. The available text suggests the sponsors are advancing a reform-oriented measure with a clear regulatory purpose rather than a compromise bill.
Likely areas of contention include the requirement that PBMs reimburse at or above actual acquisition cost plus dispensing fees, the ban on spread pricing, and the prohibition on charging pharmacies network, credentialing, claims-processing, or audit-related fees. PBMs and health plans may view these provisions as limiting contracting flexibility and potentially increasing drug benefit costs, while pharmacies are likely to support them as necessary to prevent below-cost reimbursement and retaliatory practices. The expanded authority of the Commissioner of Insurance and the bill’s interaction with ERISA, Medicaid, and federal 340B-related provisions may also draw scrutiny.