HB 194

Abstract

Over 80% of pharmaceuticals in the United States are purchased through pharmacy benefits manager (“PBM”) networks. PBMs serve as intermediaries between health plans, pharmaceutical manufacturers and pharmacies, and PBMs establish networks for consumers to receive reimbursement for drugs. Given the scope of PBMs in the healthcare delivery system, this Act is designed to provide enhanced oversight and transparency as it relates PBMs. Specifically, this Act does the following: (1) Requires PBMs to register with the Insurance Commissioner. (2) Permits the Insurance Commissioner to issue cease and desist orders based on fraudulent acts or violations of Chapter 33A of Title 18 committed by PBMs. (3) Requires PBMs to maintain certain records. (4) Permits the Insurance Commissioner to examine the affairs of PBMs. (5) Grants the Insurance Commissioner the authority to enforce Chapter 33A of Title 18 by imposing fines, requiring PBMs to take affirmative actions, and suspending, denying, or revoking a PBM’s registration. In addition, this Act updates existing law regarding maximum allowable cost lists and establishes a more transparent appeals process for a pharmacy to rely on if a PBM does not reimburse the pharmacy the amount owed under their contract or the maximum allowable cost list. Finally, this Act makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.