WeVote
Log In

Bill

Bill

SB 1186

An Act amending the act of November 21, 2016 (P.L.1318, No.169), known as the Pharmacy Audit Integrity and Transparency Act, in preliminary provisions, further providing for definitions; and, in pharmacy benefits manager contracts, providing for State pharmacy benefits manager.

2025-2026 Regular Session Introduced by Dave Argall and 13 co-sponsors

The bill aims to strengthen pharmacy audit integrity and create or designate a State-level PBM to oversee and regulate PBM activities for state programs.

Referred to Health & Human Services
0
WeVote Research Nonpartisan
Bill Summary · SB 1186

Summary of Bill: SB 1186 (Pennsylvania, 2025-2026)

Overview

SB 1186 proposes amendments to the Pharmacy Audit Integrity and Transparency Act (as enacted by November 21, 2016, P.L.1318, No.169) and adds provisions related to a State-level pharmacy benefits manager (PBM) within Pennsylvania. The bill is currently referred to the Health & Human Services committee (as of 2026-03-12). It has a broad bipartisan roster of co-sponsors.

Purpose and Intent

  • Strengthen transparency and integrity in the pharmacy audit process.
  • Create or designate a State-level pharmacy benefits manager to oversee certain PBM activities within Pennsylvania.
  • Refine definitions and preliminary provisions to support enhanced oversight, accountability, and potentially uniform administration of PBM-related duties.

Key Provisions and Changes

1) Definitions and Preliminary Provisions (amendments to the existing Act)

  • The bill revises or clarifies definitions used in the Pharmacy Audit Integrity and Transparency Act.
  • Aims to tighten the framework governing pharmacy audits, potentially including:
    • Standards for audit practices and documentation
    • Timelines for audit processing and dispute resolution
    • Requirements for transparency in audit findings, recertifications, and settlements
  • The exact changes to definitions are not enumerated in the summary, but are intended to strengthen audit integrity and reduce disputes or abuse.

2) Pharmacy Benefits Manager (PBM) Contracts; State PBM

  • The bill introduces, or expands, provisions related to a State-level PBM.
  • Potential implications include:
    • State-level oversight or direct contracting with a PBM to administer or oversee PBM services for state programs (e.g., Medicaid, state employee plans, or other state-operated pharmacy benefit programs).
    • Standards or requirements for PBM contracts, including transparency around pricing, rebates, network adequacy, and claims processing.
    • Accountability measures for PBMs operating within state programs, including audit rights, reporting requirements, and dispute mechanisms.
  • The exact scope (e.g., whether it creates a new State PBM, designates the existing PBM entity for state contracts, or imposes specific governance) is not fully detailed in the provided summary.

Who is Affected

  • Pharmacies and Pharmacy Auditors: Entities subject to the Pennsylvania Pharmacy Audit Integrity and Transparency Act may face updated definitions and revised audit procedures.
  • Pharmacy Benefits Managers (PBMs): If the bill creates or appoints a State PBM, PBMs operating under state programs would be directly affected by new contracting, oversight, and transparency requirements.
  • State Programs and Beneficiaries: State-run or state-funded pharmacy benefit programs (including Medicaid programs, state employee benefits, or other state-supported prescription drug benefits) could be impacted through changes in governance, oversight, and contract administration.
  • Healthcare Providers and Insurers/Plans: Entities interacting with PBMs and subject to audit provisions may experience changes in audit timelines, dispute resolution, and transparency obligations.

Procedural and Timeline Considerations

  • Referral: The bill has been referred to the Health & Human Services committee (March 12, 2026), indicating it is in the early stages of legislative consideration.
  • Co-sponsors: A diverse group of legislators (including bipartisan members) supports the measure, suggesting potential cross-party interest in PBM oversight and audit integrity.
  • Implementation Timeline: The text provided does not specify effective dates, transitional timelines, or phased implementation. Such details are typically defined in the bill’s text (e.g., effective date after passage, regulatory rulemaking periods, and any sunset or phasing provisions).

Potential Impacts and Considerations

  • Enhanced transparency in PBM operations and pharmacy audits could reduce disputes and improve price competitiveness and patient protections.
  • A State PBM could centralize administration of state pharmacy benefits, potentially improving consistency and oversight but also raising questions about competition, cost, and vendor management.
  • Stakeholders may seek details on:
    • How definitions are expanded or clarified (e.g., audit standards, permissible practices, and dispute timelines).
    • The governance, funding, and accountability mechanisms for a State PBM (including how contracts would be awarded and monitored).
    • Any cost implications for state programs and beneficiaries.

If you’d like, I can add a brief comparison to current Pennsylvania PBM oversight and draft a questions-for-committee checklist to accompany a hearing briefing.

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

Sign in to ask a question.