Section 602. Patient steering.
(a) Prohibitions.--A health benefit plan, health insurer or PBM contracting with a health benefit plan or health insurer may not:
(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-order pharmacy or PBM retail pharmacy affiliate.
(2) Prohibit or limit a covered individual from selecting an in-network pharmacy or in-network pharmacist of the covered individual's choice if that pharmacy or pharmacist meets and agrees to the terms and conditions, including reimbursements, in the PBM's contract.
(3) Require a covered individual to use a PBM-affiliated retail pharmacy.
(4) Transfer a covered individual's prescriptions from an in-network pharmacy to another pharmacy unless requested by the covered individual.
(5) Use financial incentives, including, but not limited to, adjustments in cost sharing obligations of a covered individual, to the exclusive benefit of a PBM-affiliated retail pharmacy.
(6) Except as provided in subsection (b), auto-enroll a covered individual in mail-order pharmacy services.
(b) Construction.--Nothing in this section shall be construed:
(1) To prevent a PBM, health benefit plan or health insurer from requiring a covered individual to use an approved specialty pharmacy operating in the PBM's network.
(2) To prevent a health benefit plan, health insurer or PBM contracting with a health benefit plan or health insurer from auto-enrolling a covered individual in mail-order services for a maintenance medication, provided that:
(i) a covered individual may not be auto-enrolled for the first 90 days of a new maintenance medication; and
(ii) a covered individual shall have the ability to opt out of mail-order pharmacy services at any time.
(602 added July 17, 2024, P.L.852, No.77)