DelawareSB 271153rd General Assembly (2024–2026)SenateWALLET

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO PHARMACY BENEFITS MANAGERS.

Sponsored By: David P. Sokola (Democratic)

Signed by Governor

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Free to download

Bill Overview

Analyzed Economic Effects

11 provisions identified: 9 benefits, 1 costs, 1 mixed.

Fewer approval barriers for patients' medicines

Pharmacy benefits managers cannot require prior approval for a covered 72-hour supply of noncontrolled medicine for an emergency condition. Approval forms must ask whether a chronic or long-term medicine may be needed for life. If the prescriber says yes, managers cannot require renewed approval more than once every 12 months. When equivalent medicines need no approval, managers must list same-class-and-family options for prescribers, before electronic prescriptions are completed. When an alternative needs approval, managers must provide information about it to pharmacies in denied-claim responses.

Patients gain prescription data privacy protections

Pharmacy benefits managers cannot share prescription data identifying patients or prescribers with affiliated pharmacies for commercial purposes. Sharing remains allowed for pharmacy payment, checking coverage drug lists, or reviewing medicine use.

Patients protected from costlier drug switches

Pharmacy benefits managers cannot require pharmacies to substitute an equivalent or alternative medicine that costs the patient more out of pocket. The rule has an exception for switches made for medical reasons that benefit the patient.

Pharmacies face fewer audit disruptions

Auditors must give pharmacies 14 days' notice and identify prescription numbers or the review date range five business days ahead. These notice rules do not apply when federal requirements prohibit them. Random sampling requires a reliable sample and a masked list at least five business days before the audit. Each entity can start only one audit per pharmacy every 12 months. Audits during a month's first five business days or federal holidays require pharmacy consent. Managers must provide a phone number, secure fax number, or an available secure portal for audit questions.

Pharmacies gain a minimum drug payment

Pharmacy benefits managers must pay at least the national average drug acquisition cost for a prescription's drug ingredient component. If that figure is unavailable, the wholesale acquisition cost applies. Both benchmarks use the date of service. This floor does not set a patient's price or guarantee patient savings.

Pharmacies gain stronger payment appeal rights

Contracted pharmacies have 40 calendar days after a fill to appeal payments below their net supplier cost or Delaware's required amount. Managers must decide within 10 calendar days after the pharmacy makes the claim and explain denials in detail. For maximum allowable cost denials, they must identify in-state wholesalers and drug codes showing available stock below that benchmark when purchased. Successful appeals require corrections back to the original claim date, without forcing the pharmacy to reverse and rebill. The original correction is due in the first payment after approval; similar later claims are due in the second. Similarly situated Delaware pharmacies receive adjustments and notice that they can reverse and rebill similar claims without separate appeals. Pharmacies qualify as similarly situated when they can meet a pharmacy type's standard terms, even without operating exclusively as that type.

Pharmacists gain protections for medicine packaging

Managers cannot require pharmacists to break unit-of-use packages beyond the manufacturer's directions when the only available package exceeds the minimum supply. A package marked 'for single-patient-use only' counts as the smallest available size.

Pharmacy audits protect costs and funds

Wholesale invoice audits can verify only inventory purchases tied to claims paid by the plan sponsor or auditing manager. Pharmacies and pharmacists can support claims with supplier invoices that hide unrelated information. Managers must pay audit costs and cannot charge pharmacies audit fees, though payment recoveries and chargebacks remain allowed. When contracts require it, auditors must give plan sponsors copies of every claim in the audit. Money recovered through audits must return to the plan sponsor.

Stronger contract protections for pharmacies

Pharmacy benefits managers must give pharmacies or pharmacists at least 60 days' notice before changing their contracts. Managers cannot retaliate solely because of qualifying disclosures, complaints, or appeals to the Commissioner. Protected disclosures concern reasonably suspected state or federal violations in legal, administrative, legislative, or investigative settings. Pharmacies must limit disclosure of confidential or proprietary information as much as possible. Conflicting secrecy terms are void in contracts made, renewed, amended, or extended after December 31, 2026.

Pharmacy contract protections start after 2026

The law applies to manager–pharmacy contracts made, renewed, amended, or extended after December 31, 2026. The same timing applies to contracts with pharmacists. Existing contracts become covered when one of those events happens after that date, not simply because the law was enacted.

Pharmacies gain review but risk costs

Pharmacies can appeal an adverse final payment decision to Delaware's Department of Insurance within 10 calendar days after receiving it. Managers must explain this right, provide the filing website, and post appeal information and contact details on their websites. The Commissioner checks compliance with Delaware's payment rule and can deny the appeal or order payment. Parties must supply requested information, and the losing party pays the Department's appeal-processing costs. Pricing data collected for review is confidential and exempt from subpoenas and public-records requests.

Sponsors & Cosponsors

Sponsor

David P. Sokola
Democratic • Senate

Cosponsors

Frank Burns
Democratic • House
Krista Griffith
Democratic • House
Gerald W. Hocker
Republican • Senate
Kyra L. Hoffner
Democratic • Senate
Larry Lambert
Democratic • House
Eric Morrison
Democratic • House
Cyndie Romer
Democratic • House
Ray Seigfried
Democratic • Senate
Claire Snyder-Hall
Democratic • House
Laura V. Sturgeon
Democratic • Senate
John "Jack" Walsh
Democratic • Senate
Madinah Wilson-Anton
Democratic • House

Roll Call Votes

All Roll Calls

Yes: 60 • No: 0

House vote • 6/24/2026

Passed (SM required)

Yes: 40 • No: 0

Senate vote • 6/9/2026