An Act amending the act of November 21, 2016 (P.L.1318, No.169), known as the Pharmacy Audit Integrity and Transparency Act, in preliminary provisions, further providing for definitions; and, in pharmacy benefits manager contracts, providing for State pharmacy benefits manager.
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Overview
This bill amends the Pharmacy Audit Integrity and Transparency Act to establish a single State pharmacy benefits manager (PBM) for Pennsylvania’s Medicaid program. It defines ‘specialty drug’ and ‘spread pricing’ and mandates that the Department of Human Services select and contract with a single PBM by July 31, 2026. The contract with the PBM will include requirements to prohibit practices like spread pricing and certain pharmacy service limitations, and must ensure payment rates are aligned with the National Average Drug Acquisition Cost guidelines.
Key provisions
- Defines ‘specialty drug’ based on cost and specific criteria related to medication handling and clinical care.
- Defines ‘spread pricing’ as a model where the PBM charges a higher price than what it pays the pharmacist.
- Requires the Department of Human Services to select and contract with a single State PBM by July 31, 2026.
- Establishes contract requirements for the State PBM, including prohibitions on spread pricing and certain pharmacy service limitations.
- Mandates that the State PBM pay pharmacy services at rates aligned with the National Average Drug Acquisition Cost guidelines.
- Requires the use of pass-through pricing.
- Specifies disclosure requirements for PBM applicants during a competitive procurement process.
- Addresses conflict of interest considerations for the selected PBM.
Who is affected
- Pennsylvania Medicaid recipients
Bill text
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Document of record
- Version
- Pn 1500 Html
- Published
- Not published in the source record
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Sponsors
Official sponsors from legislative records.
9 on record
Primary sponsor
Cosponsors
Christine Tartaglione
David Argall
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