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Bill

S 5464

Relates to reimbursements practices of pharmacy benefit managers

2025 Regular Session Introduced by Leroy Comrie

Regulates PBM reimbursement practices to boost transparency and fairness in pharmacy payments, affecting pharmacies, PBMs, insurers, and patients.

REFERRED TO HEALTH
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Bill Summary · S 5464

Summary of Bill S 5464 – Reimbursements Practices of Pharmacy Benefit Managers

Overview

  • Bill Number: S 5464
  • Title: Relates to reimbursements practices of pharmacy benefit managers
  • Status: REFERRED TO HEALTH
  • Introduced: February 21, 2025
  • Primary Sponsor: Leroy Comrie
  • Related Bills: S 6020 (prior-session), S 950 (prior-session)

This bill focuses on the reimbursement practices of pharmacy benefit managers (PBMs). The information provided does not include the specific text of provisions, so the summary below highlights what is known and explains what is typically addressed in PBM-related reform, along with the potential effects and parties involved.

Purpose and Intent

  • The bill appears intended to regulate or address how PBMs reimburse pharmacies for dispensed prescriptions.
  • By targeting reimbursement practices, the measure likely seeks greater transparency, fairness, and efficiency in the interaction between PBMs, pharmacies, and payers (insurance plans or sponsors).
  • The objective may include improving pricing clarity for pharmacies and patients and reducing practices that could affect patient out-of-pocket costs.

Key Provisions (Text Not Provided)

  • The exact provisions of S 5464 are not included in the provided materials. As such, the specific mechanisms (e.g., requirements on reimbursement formulas, transparency obligations, reporting duties, or restrictions on certain PBM practices) cannot be stated here.
  • The bill’s title suggests reforms related to how reimbursements are determined and disclosed, but definitive provisions would require the bill text.

Note: If the full text becomes available, a detailed outline of each section, defined terms, timelines, and any fiscal impact would be added.

Affected Parties

  • Pharmacies: Likely directly affected through reimbursement rates, transparency requirements, or reporting obligations.
  • Pharmacy Benefit Managers (PBMs): Core subject of regulation; changes could govern how they reimburse pharmacies and disclose information.
  • Payers/Insurers and Health Plans: May be impacted by any changes to reimbursement flows and transparency, which could influence total costs and rebates.
  • Patients: Could experience indirect effects through drug pricing transparency and possible changes in out-of-pocket costs.
  • State Health Authorities: Given the committee assignment, state health agencies or departments may implement, monitor, and enforce provisions.

Procedural and Timeline Aspects

  • Current Status: Referred to the Health Committee.
  • Actions to Watch For: In committee, the bill could undergo hearings, amendments, and a vote to move it to the broader chamber for consideration. If passed, it would proceed to the other house (if applicable) and then to the governor for signature or veto.
  • Timeline: No specific date for further action is provided in the available materials.

Related Legislation

  • S 6020 (prior-session)
  • S 950 (prior-session)

Additional Notes

  • The summary above reflects the information provided. If the full bill text or a fiscal note becomes available, a more precise section-by-section summary with expected impacts, potential cost implications, and specific regulatory requirements will be provided.

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

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