Title 27 — Title 27

This chapter shall be known as and may be cited as the Alabama Pharmacy Benefits Manager Licensure and Regulation Act. History: (Act 2019-457, §1.)

Pharmacies or Pharmacists. With respect to a pharmacist or pharmacy, a pharmacy benefits manager, directly or through an affiliate or a contracted third party, may not do any of the following: (1) Reimburse an in-network pharmacy or pharmacist in the state an amount less than the…

A pharmacy benefits manager may not knowingly make a material misrepresentation to a covered individual, pharmacist, or pharmacy. History: (Act 2021-341, §2.)

A pharmacist or pharmacy that participates in a health benefit plan’s pharmacy network shall process a prescription drug using the pharmacy benefits of the covered individual if failure to do so will result in a higher out-of-pocket cost to the covered individual. History: (Act 2…

Independent Pharmacies; Exceptions. (a) Notwithstanding any other provision of this chapter or any form of a contract to the contrary, with respect to an independent pharmacy, a pharmacy benefits manager, directly or through an affiliate or a contracted third party, may not do an…

Manufacturers. A pharmacy benefits manager, either directly or through a PBM affiliate, when performing pharmacy benefits management services or other prescription drug or device services for a health benefit plan client, shall pass on 100 percent of all rebates received, directl…

(a) This chapter establishes the standards and criteria for the regulation and licensure of pharmacy benefits managers providing claims processing services or other prescription drug or device services for health benefit plans. (b) The purpose of this chapter is to: (1) Promote, …

For purposes of this chapter, the following words have the following meanings: (1) AFFILIATE or PBM AFFILIATE. An entity, including, but not limited to, a pharmacy, health insurer, or group purchasing organization that directly or indirectly, through one or more intermediaries, h…

(a) A person may not establish or operate as a pharmacy benefits manager in this state without first obtaining a license from the commissioner. (b) Effective through December 31, 2021, to initially obtain a license or renew a license, a pharmacy benefits manager shall submit all …

(a) It shall be the responsibility of the commissioner to enforce this chapter and any conduct arising from any action taken by a pharmacy benefits manager or PBM affiliate pursuant to an audit conducted under Article 8, Chapter 23, Title 34, which violates this chapter. (b) The …

Nothing in this chapter is intended or shall be construed to do any of the following: (1) Be in conflict with existing relevant federal law. (2) Apply to any specialty drug. (3) Impact the ability of a hospital to mandate its employees’ use of a hospital- owned pharmacy. History:…

Reserved.

Individuals; Exceptions. (a) A pharmacy benefits manager may not do any of the following: (1) Require a covered individual, as a condition of payment or reimbursement, to purchase pharmacist services, including, but not limited to, prescription drugs, exclusively through a mail-o…

(a) For purposes of this section, client means a health insurer, payor, or health benefit plan. (b) If requested by a client under subsection (d), a pharmacy benefits manager shall prepare an annual report by June 1 which discloses all of the following with respect to that client…