On September 14, the Department of Insurance filed an emergency regulation in accordance with SB 188 of 2024, a comprehensive commercial market PBM reform law that included a rate floor of NADAC + a professional dispensing fee as determined by a Department of Insurance cost of dispensing study. The Department’s study determined the cost of dispensing to be $16.31. The rule, effective upon filing, will require commercial insurers and the State Employee Health Plan to pay a professional dispensing fee of $16.31 per claim to all ambulatory pharmacies beginning January 1, 2027. The regulation will remain in effect until a subsequent ordinary regulation is finalized.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.