Gov. Abigail Spanberger (D) signed SB 669 (Chapter 36)/HB 830, a key initiative of her administration to address PBM structure in the commercial market. The law will require all health insurance carriers to use a pass-through pricing model. It also will prohibit a PBM from reversing and/or resubmitting a pharmacy claim without meeting certain requirements; reducing any pharmacy payment through effective rates; and retroactively denying or reducing a claim or aggregate of claims, except under certain circumstances. Additionally, it requires the State Corporation Commission to compile a report of its examination of PBM steering practices with recommendations to the General Assembly by December 1, 2027.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.