Mississippi House Bill HB1665

Mississippi 2026 Regular Session

• Introduced: 1/19/26
• Refer: 1/19/26
• Engrossed: 2/4/26
• Refer: 2/13/26
• Failed: 3/26/26

Caption

AN ACT TO REVISE THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE NEW SECTIONS ADDED TO THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE NEW TERMS AND REVISE THE DEFINITIONS OF CERTAIN EXISTING TERMS; TO CREATE NEW SECTION 73-21-154, MISSISSIPPI CODE OF 1972, TO TRANSFER ALL POWERS AND DUTIES EXERCISED BY THE STATE BOARD OF PHARMACY UNDER THE PHARMACY BENEFIT PROMPT PAY ACT TO THE COMMISSIONER OF INSURANCE; TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO REVISE THE REIMBURSEMENT AMOUNT FROM PHARMACY BENEFIT MANAGERS AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS (PSAOS) PAYABLE TO PHARMACIES; TO REQUIRE PHARMACY BENEFIT MANAGERS TO GIVE PHARMACISTS REASONS FOR DENYING A CLAIM WITHIN SEVEN DAYS OF RECEIVING AN ELECTRONIC CLAIM; TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO DELETE PROVISIONS AUTHORIZING PHARMACY BENEFIT MANAGERS TO USE MAXIMUM ALLOWABLE COST LISTS; TO REVISE THE ADMINISTRATIVE APPEALS PROCESS PHARMACY BENEFIT MANAGERS MUST MAKE AVAILABLE TO PHARMACIES TO CHALLENGE REIMBURSEMENTS; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE PSAOS TO BE LICENSED BY THE COMMISSIONER OF INSURANCE; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO RENEW LICENSES ANNUALLY; TO REVISE THE FINANCIAL DOCUMENTS THAT MUST BE SUBMITTED TO THE COMMISSIONER WITH AN APPLICATION FOR A LICENSE OR LICENSE RENEWAL; TO CREATE NEW SECTION 73-21-157.1, MISSISSIPPI CODE OF 1972, TO CREATE A SPECIAL FUND IN THE STATE TREASURY TO SUPPORT THE OPERATIONS OF THE DEPARTMENT OF INSURANCE IN THE REGULATION OF PHARMACY BENEFIT MANAGERS; TO REQUIRE THE STATE FISCAL OFFICER TO TRANSFER UNOBLIGATED FUNDS IN THE SPECIAL FUND PREVIOUSLY USED BY THE STATE BOARD OF PHARMACY FOR THE REGULATION OF PHARMACY BENEFIT MANAGERS TO THE NEW SPECIAL FUND; TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT THE USE OF SPREAD PRICING BY PHARMACY BENEFIT MANAGERS; TO AMEND SECTION 73-21-159, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PROVISIONS OF THIS ACT; TO AMEND SECTION 73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT STEERING BY PHARMACY BENEFIT MANAGERS; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT RETALIATION AGAINST PHARMACISTS BY PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PSAOS; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO REVISE PROVISIONS RELATING TO INVESTIGATIONS AND AUDITS OF PHARMACY BENEFIT MANAGERS CONDUCTED BY THE COMMISSIONER; TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE DRUG MANUFACTURERS, PHARMACY BENEFIT MANAGERS, PSAOS AND HEALTH INSURERS TO SUBMIT CERTAIN ANNUAL REPORTS TO THE COMMISSIONER; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO REQUIRE PLAN SPONSORS TO DEVELOP CRITERIA AND A LIST OF PRESCRIPTION DRUGS DESIGNATED AS SPECIALTY DRUGS; TO CREATE NEW SECTION 73-21-168, MISSISSIPPI CODE OF 1972, TO REQUIRE THE COMMISSIONER TO DEVELOP A WEBSITE TO PUBLISH CERTAIN INFORMATION RELATED TO THIS ACT; TO CREATE NEW SECTION 73-21-169, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO IDENTIFY OWNERSHIP AFFILIATION OF ANY KIND TO THE COMMISSIONER; TO AMEND SECTIONS 73-21-83 AND 73-21-91, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PRECEDING PROVISIONS; TO AMEND SECTION 25-15-301, MISSISSIPPI CODE OF 1972, TO REQUIRE THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD TO SOLICIT REQUESTS FOR PROPOSALS FOR THE ADMINISTRATION OF THE PLAN OR COMPONENTS OF THE PLAN EVERY TWO YEARS; TO AUTHORIZE THE STATE AND SCHOOL EMPLOYEES LIFE AND HEALTH INSURANCE PLAN TO CONTRACT FOR THE MANAGEMENT OF PHARMACY BENEFITS; TO REQUIRE THE COMMISSIONER OF INSURANCE TO BE A MEMBER OF THE EVALUATION COMMITTEE WHEN CONSIDERING PROPOSALS FOR SUCH ADMINISTRATION; TO REQUIRE A PHARMACY BENEFITS MANAGER FOR THE STATE HEALTH PLAN TO COMPLY WITH THE PROVISIONS OF THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 25-15-303, MISSISSIPPI CODE OF 1972, TO REVISE THE MEMBERSHIP OF THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD; TO CREATE NEW SECTION 25-15-305, MISSISSIPPI CODE OF 1972, TO REQUIRE THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD TO DEVELOP A LIST OF PRESCRIPTION DRUGS THAT MEET THE CRITERIA ESTABLISHED BY THE BOARD FOR SPECIALTY DRUG DESIGNATION; TO REQUIRE THE BOARD TO CONSULT WITH THE ADMINISTRATORS OF THE PUBLIC EMPLOYEE HEALTH PLANS IN THE CONTIGUOUS STATES TO DETERMINE THE FEASIBILITY OF ENTERING INTO A JOINT AGREEMENT TO COMBINE PURCHASING POWER FOR PHARMACEUTICALS; TO AMEND SECTION 25-15-11, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PROVISIONS OF THIS ACT; TO BRING FORWARD SECTIONS 25-15-3, 25-15-5, 25-15-7, 25-15-9, 25-15-13, 25-15-14, 25-15-15, 25-15-16, 25-15-17, 25-15-19 AND 25-15-23, MISSISSIPPI CODE OF 1972, WHICH RELATE TO THE STATE EMPLOYEES LIFE AND HEALTH INSURANCE PLAN, FOR THE PURPOSE OF POSSIBLE AMENDMENT; TO BRING FORWARD SECTIONS 41-149-5, 41-151-7 AND 73-21-205, MISSISSIPPI CODE OF 1972, FOR THE PURPOSE OF POSSIBLE AMENDMENT; TO PROVIDE FOR SEVERABILITY; TO CREATE NEW SECTION 73-21-171, MISSISSIPPI CODE OF 1972, TO PROVIDE FOR THE REPEAL OF THE PHARMACY BENEFIT PROMPT PAY ACT; TO CREATE NEW SECTION 25-15-307, MISSISSIPPI CODE OF 1972, TO PROVIDE FOR THE REPEAL OF THOSE SECTIONS RELATING TO THE ADMINISTRATION OF THE PUBLIC EMPLOYEE HEALTH PLANS; AND FOR RELATED PURPOSES.

Impact

The bill's enactment would lead to significant changes in how pharmacy benefits are managed in Mississippi. By requiring pharmacy benefit managers to provide clear reasons for claim denials within a specified timeframe and revising the reimbursement frameworks, the bill is poised to improve cash flows to pharmacies. Furthermore, the elimination of spread pricing, where pharmacies are paid less than what PBMs charge health plans, is expected to foster more equitable financial practices in the healthcare sector while protecting patient access to necessary medications.

Summary

House Bill 1665 seeks to revise elements of the Pharmacy Benefit Prompt Pay Act, updating various sections of the Mississippi Code to enhance the operational framework surrounding pharmacy benefits. One major aspect of the bill includes transferring the regulatory powers from the State Board of Pharmacy to the Commissioner of Insurance, thereby consolidating oversight. This shift emphasizes the state's goal to enforce timely reimbursement procedures and better control over pharmacy benefit managers' (PBMs) operations, addressing challenges faced by pharmacies in processing claims and receiving payments.

Sentiment

The overall sentiment surrounding HB 1665 appears to be supportive among various stakeholders including pharmacists and consumer advocates, who argue that these changes will alleviate financial burdens and enhance service delivery within the pharmacy sector. However, there are concerns from pharmacy benefit managers and some insurance groups regarding the potential increase in operational costs and regulatory complexities due to expanded oversight and compliance requirements.

Contention

While the revisions in HB 1665 aim to enhance transparency and efficiency, they also engender contention amongst various parties. Some PBMs expressed apprehension over mandatory licensing and increased regulatory scrutiny, fearing this could disrupt existing business models. Additionally, there are ongoing discussions about the balance between enhanced regulation and the operational flexibility needed for them to manage benefits effectively. The bill’s intent to protect pharmacists against retaliation also represents a significant but contentious shift in regulatory attitudes towards how pharmacies interact with benefit managers.