A bill for an act relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions.

2025-2026 Regular Session Introduced by Sean Bagniewski and 6 co-sponsors

Bill HF 213 ensures fair access to prescription drugs by regulating pharmacy benefits managers, enhancing transparency, and allowing patients to choose any in-state pharmacy.

Introduced, referred to Commerce.

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Summary of Bill HF 213

Bill Number: HF 213
Title: A bill for an act relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions.
Status: Introduced, referred to Commerce
Introduced Date: February 06, 2025
Classification: Bill
Subject Areas: Drugs, Insurance, Mail Order Merchandise, Pharmacy, Pharmacy Benefits Managers, Prescription Drugs

Purpose and Intent

The primary purpose of Bill HF 213 is to regulate the practices of pharmacy benefits managers (PBMs) and ensure that covered individuals have fair access to prescription drug benefits. The bill aims to enhance transparency and consumer choice in the pharmacy sector, particularly regarding mail order pharmacies and the costs associated with prescription drugs.

Key Provisions

The bill introduces several significant amendments to the existing Code 2025, specifically in Section 510B:

Definition of Mail Order Pharmacy Provider:

Establishes a clear definition for "mail order pharmacy provider," which refers to pharmacies that primarily dispense prescription drugs or devices and deliver them via mail or common carrier.

Deductible Application:

Mandates that any amount paid by a covered person for a prescription drug must count towards their health benefit plan's deductible, ensuring that out-of-pocket expenses are recognized.

Choice of Pharmacy:

Prohibits health benefit plans from restricting covered individuals from filling prescriptions at any in-state pharmacy, provided that the pharmacy agrees to the same terms as those in the plan's network.

Cost-Sharing Regulations:

Prevents pharmacy benefits managers from imposing different cost-sharing amounts or additional fees based on the pharmacy where the prescription is filled, except for incentives related to value-based programs.

Mail Order Pharmacy Restrictions:

Prohibits PBMs from requiring covered individuals to purchase pharmacy services exclusively through mail order pharmacies as a condition for payment or reimbursement.

Impact

Who is Affected?

Covered Individuals: Patients will benefit from increased access to pharmacies and more predictable costs for prescription drugs.

Pharmacies: Local pharmacies may see increased business as patients are allowed to fill prescriptions at any participating pharmacy.

Pharmacy Benefits Managers: PBMs will need to adjust their practices to comply with the new regulations regarding cost-sharing and pharmacy choice.

Applicability

The provisions of this act will apply to all pharmacy benefits managers managing a health carrier’s prescription drug benefit in the state, effective from the date the act is enacted.

Procedural Aspects

The bill was introduced on February 6, 2025, and has been referred to the Commerce Committee for further consideration. The timeline for subsequent legislative actions will depend on the committee's schedule and any amendments that may be proposed.

This summary provides an overview of Bill HF 213, highlighting its intent, key provisions, and potential impacts on stakeholders within the pharmacy and healthcare sectors.