HB 631: State pharmacy benefits manager; contractual provisions, report.

Official summary

Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.

State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.

Sponsors

Sponsors by party (alphabetical): Democratic 3 · Republican 1

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. February 18, 2026Left in Committee Appropriations
2. February 13, 2026Subcommittee recommends laying on the table (6-Y 1-N)
3. February 5, 2026Assigned HAPP sub: Health & Human Resources
4. February 5, 2026Reported from Labor and Commerce with amendment(s) and referred to Appropriations (21-Y 1-N)
5. February 4, 2026Fiscal Impact Statement from Department of Planning and Budget (HB631)
6. February 3, 2026Subcommittee recommends reporting with amendment(s) and referring to Appropriations (9-Y 0-N)
7. February 3, 2026House subcommittee offered
8. January 20, 2026Assigned HCL sub: Subcommittee #1
9. January 13, 2026Referred to Committee on Labor and Commerce
10. January 13, 2026Prefiled and ordered printed; Offered 01-14-2026 26103637D