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Committee advances PBM reimbursement bill, requires faster clean‑claim turnaround and penalties
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 claim,' require electronic reimbursements within 7–14 days and 30 days for paper claims, and impose a 12% per‑month penalty for late payments on clean claims.
Lawmakers asked how the penalty would be enforced and whether existing insurance‑department mechanisms would cover enforcement. Gramlich said the Insurance Department already uses similar mechanisms for medical claims and that the department could apply the same process to PBMs. Committee members expressed skepticism that penalties alone would deter large PBMs but acknowledged the cash‑flow problem for independent pharmacies.
After limited public comment and member questions, the committee passed HB16‑20 on a voice vote and recommended it to the full House.
What happens next: The bill proceeds to the House calendar for full consideration; the transcript records a voice vote but no roll call.
