HB 5365
Relating to the regulation of pharmacy benefit managers providing services to the Public Employees Insurance Agency.
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to strengthen the Public Employees Insurance Agency’s (PEIA) oversight of pharmacy benefit managers (PBMs) that provide services to state employees. It creates a special investigative unit within PEIA, grants the Insurance Commissioner increased authority to investigate potential violations, and requires PBMs to provide detailed reporting on claims and reimbursement practices. The bill also addresses issues like specialty drug definitions and transparency in PBM operations, with the goal of ensuring fair pricing and preventing fraud.
Key provisions
- Establishes a special investigative unit within PEIA to investigate potential fraud and abuse related to pharmacy benefit management.
- Grants the Insurance Commissioner expanded authority to investigate and enforce compliance with pharmacy benefit management practices.
- Requires PBMs to report quarterly on claims data, including reimbursement amounts and the number of claims with discrepancies.
- Mandates transparency in PBM contracts, including requirements for national average drug acquisition cost comparisons.
- Defines key terms related to pharmacy benefits, such as ‘specialty drug’ and ‘remote patient monitoring services’.
- Authorizes PEIA to recover fraudulently paid benefits and funds from employers.
- Requires PBMs to offer pharmacy services exclusively through mail-order pharmacies.
- Establishes a process for PEIA to terminate contracts with PBMs that violate regulations.
Who is affected
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