Section 601. Contract provisions.
(a) General rule.--A PBM registered with the department and conducting business on behalf of a health insurer client in this Commonwealth may not:
(1) Reimburse a retail pharmacy an amount less than the amount that the PBM reimburses a PBM-affiliated retail pharmacy located in this Commonwealth for providing the same pharmacist services.
(2) Reimburse a federally qualified health center, health care facility or other entity participating in the program under section 340(b) of the Public Health Service Act (58 Stat. 682, 42 U.S.C. § 256(b)) an amount lesser than similar entities not participating in the program.
(3) Authorize the PBM to unilaterally alter the terms of a participation contract beyond the terms and conditions of the original contract agreed to by a PSAO or pharmacy with a PBM beyond the terms and conditions of the original contract agreed to by the pharmacy or PSAO with a PBM.
(4) Designate a prescription drug as a specialty drug or require a prescription drug to be dispensed exclusively at a specialty pharmacy unless it meets the criteria of a specialty drug under section 103.
(b) Rebates.--Beginning on the effective date of this section, a PBM shall pass through to the health benefit plan no less than 95% of any prescription drug manufacturer rebate obtained by the PBM on behalf of a health insurer client if the health benefit plan delegates negotiation of the rebate to the PBM.
(c) Contract information.--PBM contracts shall provide information to a pharmacist, pharmacy or PSAO pertaining to the schedule and total for any fee charged by the PBM for participation in the PBM's network.
(601 added July 17, 2024, P.L.852, No.77)