Bill Summary: HB 25-1094 — Pharmacy Benefit Manager Practices
Status: Governor Signed (2025-05-30)
Introduced: 2025-01-27
Jurisdiction: State bill (HB prefix) — bill text not provided
Note: The legislative text for HB 25-1094 was not included with your request. The summary below (1) records the bill’s procedural history and sponsors, and (2) describes the likely purpose, typical provisions, affected parties, and expected impacts consistent with bills titled “Pharmacy Benefit Manager Practices.” For precise legal obligations, consult the enacted bill text and implementing regulations.
Purpose and intent
HB 25-1094 concerns the regulation of pharmacy benefit managers (PBMs). Such laws commonly aim to increase transparency of PBM contracting and pricing, protect independent and community pharmacies, limit certain PBM practices (e.g., spread pricing, undisclosed fees, retroactive adjustments), and improve patient access and affordability for prescription medicines.
Key provisions (typical for “PBM practices” bills)
While the exact language is not available, the bill likely includes some or all of the following types of provisions:
- Licensing/registration: Requires PBMs to register or be licensed with a state regulator (insurance or commerce).
- Transparency and reporting: Mandates PBM reporting to the state of rebate amounts, administrative fees, spread pricing, and pharmacy reimbursement methodologies; regular public or regulator reports.
- Prohibition or limitation of spread pricing: Bans or limits PBMs from charging a plan sponsor more than they pay pharmacies for a prescription (requires pass-through pricing or disclosure).
- Limits on clawbacks/DIR fees: Restricts retroactive pharmacy price adjustments and direct and indirect remuneration (DIR) fees that reduce final pharmacy reimbursement.
- Reimbursement standards: Sets minimum pharmacy reimbursement standards or requires contracts to disclose how reimbursements are calculated (e.g., based on AWP, NADAC, MAC lists).
- Anti-steering and gag clauses: Prohibits PBMs from blocking pharmacists from informing patients about lower-cost alternatives or cash prices.
- Pharmacy network/access protections: Protects pharmacies from arbitrary network exclusions, requires notice before contract termination.
- Consumer protections: Requires point-of-sale transparency on patient cost-sharing and clarifies how rebates affect out-of-pocket costs.
- Enforcement and penalties: Grants regulatory enforcement authority and sets civil penalties for noncompliance.
Who is affected
- PBMs: New registration, reporting, operational and contractual changes, potential limits on revenue models.
- Pharmacies: Potentially improved reimbursement transparency and reductions in retroactive adjustments; greater negotiating leverage.
- Health insurers, employers, and plan sponsors: Changes in PBM contracting and pricing models may affect plan costs and premium dynamics.
- Patients: Potentially lower out‑of‑pocket costs and better information at point-of-sale; access changes depending on network/contract outcomes.
- State agencies: Administrative burden to implement, receive reports, enforce compliance — possible budgetary impact.
Procedural timeline and sponsors
Key actions:
- Introduced in House: 2025-01-27
- Passed House (third reading): 2025-03-17
- Passed Senate with amendments and concurrence actions: March–May 2025
- Sent to Governor: 2025-05-13
- Governor Signed: 2025-05-30
Primary sponsors (as listed): Dylan Roberts; Kyle Brown; Dusty Johnson; Byron Pelton. Numerous cosponsors from both chambers are listed.
Next steps / Implementation
- Check the enacted bill text for exact provisions, definitions, effective date, and appropriation or rulemaking directions.
- Watch for administrative rulemaking or guidance from the designated state regulator (often departments of insurance/health/commerce).
- Stakeholders (PBMs, pharmacies, payers) should inventory contracts, reporting systems, and compliance plans in anticipation of operational changes.
