State employees health plan; set provisions and restrictions related to pharmacy benefit manager.
Impact
The bill introduces several critical requirements for PBMs. Notably, it establishes a minimum reimbursement standard for pharmacies, ensuring that a PBM cannot reimburse a pharmacy less than the national average drug acquisition cost plus a professional dispensing fee. Furthermore, it prohibits PBMs from charging higher amounts to plan sponsors than the net reimbursement paid to pharmacies, aiming to enhance financial transparency and accountability within the pharmacy benefit system. This approach is intended to benefit state employees by ensuring fair compensation for pharmacy services and mitigating issues related to delayed payments.
Summary
Senate Bill 2738 amends the Mississippi Code to introduce significant changes to the management and operation of pharmacy benefit managers (PBM) in relation to state and school employee health insurance plans. The bill mandates that the Executive Director of the Mississippi Board of Pharmacy be included in the evaluation committee for proposals related to pharmacy benefits, ensuring oversight from a key regulatory figure. This inclusion aims to enhance the integrity and effectiveness of the evaluation process for pharmacy benefit management services.
Contention
There are several notable points of contention surrounding SB2738, particularly regarding the compliance requirements it imposes on PBMs. Critics may argue that these regulations could strain operations for some PBM affiliates and potentially limit their flexibility in managing pharmacy networks. Moreover, the bill addresses penalties for non-compliance, which could lead to heightened administrative burdens for PBMs. The requirement for PBMs to disclose all contracts and their adherence to certain operational standards aims to curb unethical practices, but could also be viewed by some industry stakeholders as excessive governmental oversight.
Amends and adds to existing law to establish provisions regarding dispensing fees and to establish duties and restrictions pertaining to pharmacy benefit managers and third-party payers.