Pennsylvania House Bill HB2431

Pennsylvania 2025-2026 Regular Session

• Introduced: 4/21/26
• Refer: 4/21/26

Caption

In enforcements, further providing for scope of enforcement authority.

Summary

HB2431 amends Pennsylvania’s Pharmacy Audit Integrity and Transparency Act to add a new enforcement provision focused on Medicaid pharmacy access. The bill requires pharmacy benefit managers (PBMs) to accept and process Medicaid prescriptions from any pharmacy or pharmacist that is in good standing with the Department of Health and the State Board of Pharmacy. It also prohibits PBMs from restricting, limiting, or otherwise controlling which pharmacies Medicaid patients may use based solely on the PBM’s private contracting preferences. In practical terms, the bill is aimed at preventing PBMs from steering Medicaid patients toward a narrower network of pharmacies when the pharmacy is otherwise properly licensed and eligible to serve patients. The measure would take effect 60 days after enactment and would expand the scope of enforcement authority under the existing 2016 law governing PBM practices, pharmacy audits, and related transparency requirements.

Impact

The bill would amend section 901 of the Pharmacy Audit Integrity and Transparency Act by adding a new subsection specifically addressing Medicaid pharmacy access. It would create a statutory requirement that PBMs process Medicaid claims from any qualified pharmacy and would bar network or access restrictions tied only to PBM contracting choices. This would affect PBMs, pharmacies, pharmacists, and Medicaid patients by limiting PBM discretion over pharmacy selection in the Medicaid context and giving regulators a clearer basis to enforce access protections.

Sentiment

No committee transcript or vote history is provided, so there is no recorded debate or roll-call evidence to indicate support or opposition. Based on the bill text, the measure appears consumer- and provider-protective, with an emphasis on pharmacy access and limiting PBM control, which typically aligns with concerns about patient choice and independent pharmacy participation. The absence of discussion or votes means the overall sentiment cannot be measured beyond the bill’s apparent policy direction.

Contention

The main point of potential contention is the restriction on PBMs’ ability to use private contracting preferences to shape Medicaid pharmacy networks. PBMs may view the bill as limiting their contracting flexibility and network management tools, while pharmacies and patient advocates are likely to support the requirement as a safeguard for access and choice. Another possible area of dispute is whether the bill could affect cost management or preferred-network arrangements in Medicaid, though the text itself focuses only on access and does not address pricing or reimbursement terms.