A person or organization shall not establish or operate as pharmacy benefits manager for health benefit plans without obtaining a license from the Insurance Commissioner.
Sets initial, renewal application fee for pharmacy benefits manager license to $20,000.
Renewal application and renewal application fee required annually, commissioner may reduce fee if constitute financial hardship that would prevent PBM from doing business.
Pharmacy benefits manager may differentiate different health benefit plans, networks, or benefit packages with the use of a unique number or other form of identification.
At renewal, PBM shall report each pharmacy claims bank identification number, pharmacy claims group number, and pharmacy claims processor control number.
Also report each unique combination for pharmacy claims, claims by estimated number of covered lives in each combination, as well as claims by plan type and network.
Pharmacy claims group number may be used to process claim, group number is not required for submission of a clean pharmacy claim unless needed to identify network.
Legislative History
On Feb. 26, 2025, bill was introduced in House; on Mar. 17, 2025, bill passed House.
On Mar. 17, 2025, bill was introduced in Senate; on Apr. 8, 2025, bill passed Senate.
On Apr. 10, 2025, House concurred Senate amendments and sent bill to enrolling.
On Apr. 16, 2025, bill was signed into law by the governor and assigned Act 633.
Effectiveness
Act effective 91 days after legislature adjourned sine die (May 5), so Aug. 4, 2025.
