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SSB 1074

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

2025-2026 Regular Session

SSB 1074 ensures pharmacies can equally participate in health plans, mandates transparency for patients, and imposes stricter rules on pharmacy benefits managers.

Committee report approving bill, renumbered as SF 383.
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Bill Summary · SSB 1074

Summary of SSB 1074 - Pharmacy Benefits Managers and Prescription Drugs

Bill Overview

Bill Number: SSB 1074
Title: A bill for an act relating to pharmacy benefits managers, pharmacies, and prescription drugs and including applicability provisions.
Status: Approved by committee, renumbered as SF 383
Introduced: January 29, 2025
Classification: Proposed bill
Subject Areas: Drugs, Health Insurance, Pharmacy Benefits Managers, Prescription Drugs, Third-Party Payors

Purpose and Intent

The primary intent of SSB 1074 is to regulate the interactions between pharmacy benefits managers (PBMs), pharmacies, and third-party payors regarding the provision of prescription drugs. The bill aims to enhance transparency and fairness in the pharmacy benefits system, ensuring that pharmacies have equal opportunities to participate in health benefit plans and that covered persons are informed about their options.

Key Provisions

  1. Notification Requirement:

    • Third-party payors must notify all pharmacies within the geographical coverage area of any restrictions on pharmacy participation in health benefit plans at least 60 days prior to the effective date of such restrictions.

  2. Equal Participation:

    • All pharmacies in the specified geographical area are eligible to participate in health benefit plans under identical reimbursement terms for providing pharmacy services and prescription drugs.

  3. Information Disclosure:

    • Third-party payors are required to inform covered persons about the names and locations of all participating pharmacies that provide pharmacy services and prescription drugs.

  4. Pharmacy Rights:

    • Participating pharmacies are entitled to announce their participation in health benefit plans to their customers.

  5. Compliance and Enforcement:

    • The commissioner will not certify or license any pharmacy benefits manager or insurance producer that fails to comply with the provisions of this bill.

  6. Legal Recourse:

    • Covered persons or pharmacies harmed by violations of this bill may pursue legal action to stop the continuation of such violations.

  7. Exemptions:

    • The bill does not apply to entities that own and operate their own facilities and dispense prescription drugs exclusively to their employees and dependents, unless they contract with outside pharmacies for additional services.

Impact

  • Pharmacies: The bill is designed to level the playing field for pharmacies, allowing them to participate equally in health benefit plans and ensuring they are informed of any changes that may affect their business.
  • Covered Persons: Patients will benefit from increased transparency regarding which pharmacies are available to them under their health plans, potentially leading to better access to medications.
  • Pharmacy Benefits Managers: PBMs will face stricter regulations and compliance requirements, which may affect their operational practices.

Legislative Timeline

  • January 29, 2025: Bill introduced and referred to the Health and Human Services Committee.
  • February 4, 2025: Subcommittee meeting held.
  • February 5, 2025: Subcommittee recommends passage of the bill.
  • February 19, 2025: Committee report approving the bill, renumbered as SF 383.

This summary provides a comprehensive overview of SSB 1074, highlighting its purpose, key provisions, and potential impact on pharmacies and covered persons in the healthcare system.

Compiled from official sources — confirm details with the bill’s official record.

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