UtahH.B. 5272026 General SessionHouse

Pharmacy Pricing Amendments

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 1 costs, 0 mixed.

Pharmacies gain pricing information and appeals

Beginning May 6, 2026, pharmacy benefit managers using maximum allowable cost reimbursement must give network pharmacies pricing lists on request. These electronic, searchable lists must show each covered drug’s national drug code and maximum payment amount. Pharmacies have 21 days after a claim’s first payment decision to appeal, directly or through a pharmacy services administrative organization. Managers must provide a dedicated phone number, email address, and website for appeals, and accept paper or electronic documents. Denials must explain the reason and identify a drug’s national code and evidence of availability at or below that price. Managers must adjust payment when an appeal succeeds or they cannot show a similar pharmacy can obtain the drug at that price. They must allow free claim reversal and resubmission, and consider further corrective action. These rules exclude Medicaid services and do not directly lower household drug prices.

Drug benefit managers face daily penalties

Beginning May 6, 2026, Utah’s insurance commissioner can order pharmacy benefit managers to pay the state for violations. The penalty is up to $2,500 per violation. Each day a violation continues counts as a separate violation. Managers pay these penalties, not households.

Sponsors & Cosponsors

Sponsor

Katy Hall
Republican • House

Cosponsors

Evan J. Vickers
Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 176 • No: 3

Senate vote • 3/6/2026

Senate/ substituted

Yes: 0 • No: 0

Senate vote • 3/6/2026

Senate/ passed 2nd & 3rd readings/ suspension

Yes: 24 • No: 0

House vote • 3/6/2026

House/ concurs with Senate amendment

Yes: 66 • No: 1

Senate vote • 3/2/2026

Senate Comm - Favorable Recommendation

Yes: 2 • No: 1

House vote • 2/27/2026

House/ passed 3rd reading

Yes: 62 • No: 1

House vote • 2/27/2026

House/ substituted

Yes: 0 • No: 0

House vote • 2/24/2026

House Comm - Favorable Recommendation

Yes: 11 • No: 0