HB 2270
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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Sign in to take action- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill amends the Pharmacy Audit Integrity and Transparency Act to establish a single State pharmacy benefits manager (PBM) for all Medicaid recipients in Pennsylvania. It defines ‘specialty drug’ and ‘spread pricing’ and requires the Department of Human Services to select and contract with such a PBM by July 31, 2026. The contract must prohibit certain practices, including spread pricing and requirements that limit pharmacy choices for enrollees, and ensure payment rates are aligned with wholesale acquisition costs and Medicaid fee-for-service dispensing fees.
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 health plan a higher price than it pays the pharmacist.
- Requires the Department of Human Services to select and contract with a single State pharmacy benefits manager by July 31, 2026.
- Mandates that managed care contracts include the State PBM.
- Prohibits the State PBM from requiring enrollees to obtain prescriptions exclusively through mail order pharmacies.
- Requires the State PBM to pay pharmacy rates aligned with National Average Drug Acquisition Cost guidelines or wholesale acquisition cost.
- Requires the use of ‘pass-through pricing’ in the PBM contract.
- Establishes a procurement process for selecting the State PBM, including conflict of interest disclosures.
Who is affected
- Medicaid recipients
- Pharmacy Benefit Managers (PBMs)
Sponsors
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Primary sponsor
Robert Matzie
Cosponsors
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