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 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 FROM USING 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 STATE BOARD OF PHARMACY; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO RENEW LICENSES ANNUALLY; TO REVISE THE FINANCIAL DOCUMENTS THAT MUST BE SUBMITTED TO THE BOARD WITH AN APPLICATION FOR A LICENSE OR LICENSE RENEWAL; TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT THE USE OF SPREAD PRICING BY PHARMACY BENEFIT MANAGERS; TO BRING FORWARD SECTION 73-21-159, MISSISSIPPI CODE OF 1972, WHICH RELATES TO FINANCIAL EXAMINATIONS OF PHARMACY BENEFIT MANAGERS, FOR PURPOSES OF POSSIBLE AMENDMENT; 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 BOARD; TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO SUBMIT CERTAIN ANNUAL REPORTS TO THE BOARD; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO CREATE THE MISSISSIPPI SPECIALTY DRUG COMMITTEE; TO CREATE NEW SECTION 73-21-211, MISSISSIPPI CODE OF 1972, TO DESIGNATE CERTAIN NEWLY CREATED STATUTES AS THE PHARMACY FAIR COMPETITION ACT; TO CREATE NEW SECTION 73-21-213, MISSISSIPPI CODE OF 1972, TO DECLARE CERTAIN LEGISLATIVE FINDINGS RELATING TO THE DISTRIBUTION AND RETAIL SALE OF PHARMACEUTICAL DRUGS AND THE PUBLIC NECESSITY TO REGULATE AND LICENSE CERTAIN PHARMACEUTICAL INDUSTRIES; TO CREATE NEW SECTION 73-15-215, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS FROM HOLDING A PHARMACY PERMIT FOR THE RETAIL SALE OF DRUGS; TO AUTHORIZE THE BOARD TO ISSUE LIMITED USE PERMITS FOR THE SALE OF RARE DRUGS UNDER CERTAIN CIRCUMSTANCES; TO CREATE NEW SECTION 73-21-217, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD TO ASSESS EACH ACTIVE RETAIL PHARMACY PERMIT TO DETERMINE IF THE PERMIT HOLDER IS IN VIOLATION OF SECTION 73-21-215, MISSISSIPPI CODE OF 1972; TO AMEND SECTION 25-15-301, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE STATE AND SCHOOL EMPLOYEES LIFE AND HEALTH INSURANCE PLAN TO CONTRACT FOR THE MANAGEMENT OF PHARMACY BENEFITS; TO REQUIRE THE EXECUTIVE DIRECTOR OF THE STATE BOARD OF PHARMACY 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 ADD THE EXECUTIVE DIRECTOR OF THE STATE BOARD OF PHARMACY TO THE MEMBERSHIP OF THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD; AND FOR RELATED PURPOSES.
HB 1672 substantially revises Mississippi’s Pharmacy Benefit Prompt Pay Act and adds a new “Pharmacy Fair Competition Act” framework. The bill expands the State Board of Pharmacy’s oversight of pharmacy benefit managers (PBMs) and pharmacy services administrative organizations (PSAOs) by requiring licensure, annual renewal, financial reporting, and more detailed disclosures about rebates, reimbursement spreads, formulary changes, and differences between affiliated and non-affiliated pharmacies. It also tightens prompt-pay rules by requiring faster payment of clean electronic claims, written explanations for denied claims within seven days, and interest penalties for late payment.
The bill also prohibits several PBM practices that are often criticized by pharmacies, including spread pricing, steering patients to affiliated pharmacies, retaliation against pharmacies that assert their rights, and charging certain network or claim-processing fees. It revises maximum allowable cost (MAC) list rules, strengthens appeal rights for pharmacies challenging reimbursement levels, and requires PBMs to pay at least the greater of pharmacy acquisition cost or Medicaid reimbursement benchmarks in certain circumstances. In addition, it creates a Mississippi Specialty Drug Committee to establish and maintain a specialty drug list that PBMs must follow when setting payment levels and adjudicating claims.
HB 1672 would significantly expand state regulation of PBMs and PSAOs by amending existing code sections and creating multiple new statutory provisions. It would place these entities under more direct licensing, reporting, audit, and penalty authority of the State Board of Pharmacy, while also adding new restrictions on ownership, pricing practices, network conduct, and patient steering. The bill would also affect the State and School Employees Health Insurance Plan by requiring PBM contractors for the state plan to comply with the Pharmacy Benefit Prompt Pay Act and by adding the State Board of Pharmacy executive director to relevant evaluation and management bodies.
The bill’s overall policy direction is strongly pro-pharmacy and pro-transparency, with the text reflecting a clear legislative intent to curb PBM market power and protect independent pharmacies, patients, and plan sponsors from hidden pricing practices. Although no committee transcript or vote record is provided, the structure and findings section suggest the bill is designed to respond to concerns about unfair reimbursement, affiliate favoritism, and lack of disclosure in prescription drug pricing. The absence of recorded votes or discussion means there is no documented opposition or support in the provided materials, but the bill itself is framed as a consumer- and competition-focused reform measure.
The most likely points of contention are the bill’s broad restrictions on PBM business models and its potential impact on existing contracting arrangements. PBMs and their affiliates may object to the spread-pricing ban, rebate pass-through requirement, limits on MAC pricing, mandatory disclosure of proprietary financial information, and the prohibition on holding retail pharmacy permits. Pharmacies, especially independent pharmacies, are likely to support these provisions, while PBMs, insurers, and plan sponsors may raise concerns about administrative burden, confidentiality, market disruption, and the effect on drug benefit costs. The bill also creates a limited-use permit process for rare or orphan drugs, which appears intended to address access concerns that could arise from the ownership ban.