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Committee advances PBM reimbursement bill, requires faster clean‑claim turnaround and penalties
INSURANCE & COMMERCE- HOUSE · March 5, 2025
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Summary
HB16‑20 would require PBMs to reimburse pharmacies within 7–14 days for electronic claims and within 30 days for paper claims, defines clean claims and imposes a 12% per‑month penalty for late payment; the committee voted to pass the bill after sponsor testimony and questions about enforcement.
Representative Zach Gramlich presented House Bill 16‑20 to address long delays by pharmacy benefit managers (PBMs) in reimbursing pharmacies. Gramlich told the committee that some pharmacies report waits of up to 150 days for reimbursement and that the bill would: define a 'clean…
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