HB1271
Health insurance; pharmacy benefits managers; requirements and prohibited conduct.
Status:
In House
Latest Action:
Jan. 27, 2026
House: Assigned HCL sub: Subcommittee #1
Chief Patron:
Otto Wachsmann (R)
Session:
2026 Regular Session
Summary
As Introduced. Health insurance; pharmacy benefits managers; requirements and prohibited conduct; retail pharmacy network access standards; enforcement; civil penalty.
Amends the definition of 'pharmacy benefits management' to exclude certain activities and amends certain provisions related to prohibited conduct by health carriers and pharmacy benefits managers (PBMs). The bill prohibits a health carrier or PBM from denying a pharmacy the opportunity to participate in a network at preferred status if ... (More) the pharmacy is willing to accept the same terms and conditions as other pharmacies that receive preferred status. The bill prohibits a health carrier or PBM from retroactively denying or reducing reimbursement for a covered service claim, except in certain circumstances. The bill also prohibits health carriers and PBMs from failing to make a payment due to a pharmacy or pharmacist upon termination from a network and from charging a pharmacist or pharmacy a fee related to participation in a PBM's network. Under the bill, no PBM shall restrict a pharmacy from informing an individual of any differential between the individual's out-of-pocket costs and the amount the individual would pay to purchase the drug directly or through the individual's health insurance coverage. The bill also requires PBMs to establish and maintain an electronic claim inquiry processing system using national standards to provide certain disclosures and to maintain records of network development activities. The bill prohibits a PBM from including the name of any pharmacy or hospital in any material issued by the PBM unless it lists all pharmacies participating in the preferred and nonpreferred pharmacy and health networks. (Less)-
Bill History
- 01/14/2026 - House: Prefiled and ordered printed; Offered 01-14-2026 26101229D
- 01/14/2026 - House: Referred to Committee on Labor and Commerce
- 01/27/2026 - House: Assigned HCL sub: Subcommittee #1
