HB 25-1222

House Bill 25-1222, titled "Preserving Access to Rural Independent Pharmacies," aims to help rural independent pharmacies by ensuring they can use private couriers or delivery services to deliver medications to patients. The bill also requires pharmacy benefit managers (PBMs) to reimburse these pharmacies at least the national average cost for drugs and a dispensing fee. Additionally, it provides protections for rural pharmacies during audits conducted by PBMs, giving them ample time to appeal any penalties or recoupments over $1,000. This legislation benefits rural independent pharmacies and their patients by ensuring better access to medications and fair reimbursement practices. Since the bill has been signed into law, these provisions are now in effect.

Official Summary

The act prevents a pharmacy benefit manager (PBM) from prohibiting a rural independent pharmacy from using a private courier or a delivery service to deliver a prescription drug to a patient. A PBM is required to reimburse a rural independent pharmacy for a prescription drug in an amount not less than the national average drug acquisition cost for the dispensed prescription drug ingredients, plus pay a dispensing fee. When a PBM conducts an audit of a rural independent pharmacy and the audit results in a recoupment of more than $1,000 or a penalty of more than $1,000, the PBM must: Electronically notify the rural independent pharmacy of the rural independent pharmacy's rights to appeal at least 30 days before the recoupment of funds; If the rural independent pharmacy does not respond to the electronic notification within 30 days after the electronic notification, again electronically notify the rural independent pharmacy of the rural independent pharmacy's rights to appeal at least 30 days before the recoupment of funds; and If the rural independent pharmacy does not respond to the second electronic notification within 30 days after the second electronic notification, serve process on the rural independent pharmacy notifying of the rural independent pharmacy's rights to appeal at least 30 days before the recoupment of funds. The act allows a rural independent pharmacy to operate without being under the direct charge of a pharmacist if the initial interpretation and final evaluation of the prescription is done by a state-licensed pharmacist in person or remotely. (Note: This summary applies to this bill as enacted.)

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