State pharmacy benefits manager; contractual provisions, report.
Sponsored By: Aaron R. Rouse (Democratic)
In Committee
Summary
State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.
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Bill Overview
No Economic Impacts Identified for this Bill
Sponsors & Cosponsors
Sponsor
Aaron R. Rouse
Democratic • Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Continued from last session
7/21/2026SenateContinued to 2027 in Finance and Appropriations (14-Y 1-N)
2/11/2026SenateFiscal Impact Statement from Department of Planning and Budget (SB668)
2/4/2026SenateReported from Commerce and Labor and rereferred to Finance and Appropriations (11-Y 1-N)
2/2/2026SenateRereferred from Education and Health to Commerce and Labor (13-Y 0-N)
1/29/2026SenateReferred to Committee on Education and Health
1/14/2026SenatePrefiled and ordered printed; Offered 01-14-2026 26103768D
1/14/2026Senate
Bill Text
Introduced
1/14/2026
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