HB631
State pharmacy benefits manager; contractual provisions, report.
Status:
In House
Latest Action:
Feb. 5, 2026
House: Assigned HAPP sub: Health & Human Resources
Chief Patron:
Katrina Callsen (D)
Session:
2026 Regular Session
Summary
As Introduced. State pharmacy benefits manager; contractual provisions; report.
Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined ... (More) by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. (Less)-
Bill History
- 01/13/2026 - House: Prefiled and ordered printed; Offered 01-14-2026 26103637D
- 01/13/2026 - House: Referred to Committee on Labor and Commerce
- 01/20/2026 - House: Assigned HCL sub: Subcommittee #1
- 01/30/2026 - House: Placed on Labor and Commerce Agenda
- 02/03/2026 - House: House subcommittee offered
- 02/03/2026 - House: Subcommittee recommends reporting with amendment(s) and referring to Appropriations (9-Y 0-N)
- 02/04/2026 - House: Placed on Labor and Commerce Agenda
- 02/04/2026 - House: Fiscal Impact Statement from Department of Planning and Budget (HB631)
- 02/05/2026 - House: Reported from Labor and Commerce with amendment(s) and referred to Appropriations
- 02/05/2026 - House: Referred to Committee on Appropriations
- 02/05/2026 - House: Assigned HAPP sub: Health & Human Resources
