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Committee passes Senate Bill 140 with pharmacy network, reimbursement and PBM provisions
Summary
The committee passed Senate Bill 140 as amended, adding pharmacy network adequacy requirements, reimbursement parity limits on PBMs, and a NADAC-based minimum reimbursement with a CMS dispensing fee for certain independent pharmacies. Amendments were accepted by consent and the bill passed unanimously on the roll call.
The committee passed Senate Bill 140 as amended, adopting two amendments taken by consent and approving the bill on a recorded roll call.
Representative Lehman introduced amendments to Senate Bill 140 that the sponsors said remove earlier vertical-integration divestiture language and instead address pharmacy network adequacy, reimbursement parity and PBM conduct. The amendment requires plans to "offer in person pharmacy options within 30 miles of a covered person's home, to the extent that they're available within 30 miles," and obliges plans to allow any pharmacy willing to accept contract terms to contract with the plan, the sponsor said.
The amendment also bans clawbacks and holdbacks of claims paid to a pharmacy except where the claim is fraudulent or there was an actual overpayment. It prohibits a PBM…
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