State Laws Prohibiting Reimbursement Discrimination by PBMs:
States which prohibit a PBM from reimbursing a non-affiliated pharmacy in an amount less than the PBM would reimburse an affiliate pharmacy; prohibits a PBM from refusing to contract with or imposing more restrictive contractual terms on a non-affiliated pharmacy.
*Noticeably absent from the map is Mississippi. This law would have been addressed in Section 4 of HB 1123. Mississippi does have a Prompt Pay Act law requiring PBMs to pay pharmacies a minimum cost of the medication; however, some PBMs fail to adhere to this law or find ways to circumvent the law altogether through "loopholes" in the language furthering the need for revisions or a new law.
Source: https://nashp.org/state-tracker/state-pharmacy-benefit-manager-legislation/
State Laws Requiring Reimbursement Requirements to Pharmacies by PBMs:
Reimbursement requirements include:
-prohibits a PBM from paying a pharmacy for a drug less than NADAC or WAC;
*Noticeably absent from the map is Mississippi. This law would have been addressed in HB 1123 but was removed.
Source: https://nashp.org/state-tracker/state-pharmacy-benefit-manager-legislation/
State Laws Requiring PBMs to Report Rebate or Other Information to the State:
Requires a PBM to report information, including aggregate rebates, to certain state departments, most often to the Board of Pharmacy or Insurance Commissioner.
*Noticeably absent from the map is Mississippi. This law would have been addressed in HB 1123 under ERISA.
Source: https://nashp.org/state-tracker/state-pharmacy-benefit-manager-legislation/
State Laws Preventing "STEERING" to Affiliated PBM Pharmacy:
Prevents PBMs from "steering" or requiring patients to use affiliated pharmacies or mail order affiliated pharmacies. Allows patients to continue to use the pharmacy of choice to fulfill prescription drug needs.
*MS has 73-21-161 but it is currently difficult to enforce and excludes state healthcare plans. It is also important to note that Mississippi is the ONLY state that excludes State Employee health plans from this law. MS State Health Insurance Plans: ~197,000 lives, Medicaid and CHIP: ~642,000 lives, and Affordable Care Act Marketplace: ~273,579 lives. This provision essentially "guts" the law from doing what it was intended to accomplish.
Source: https://nashp.org/state-tracker/state-pharmacy-benefit-manager-legislation/