Back to Wyoming
Wyoming2016Enacted

HB0035

Wyoming Pharmacy Benefit Manager Regulation Act

Last scannedOct 18, 2026, 2:19 AM

In one sentence

This law requires pharmacy benefit managers in Wyoming to be licensed and sets specific rules for how they audit pharmacies and determine drug prices.

What it does

  • Requires pharmacy benefit managers to obtain a license from the Department of Insurance to operate in Wyoming.
  • Establishes procedures for pharmacy benefit managers to audit pharmacies, including providing written notice at least 10 business days before an on-site audit.
  • Limits the time period covered by audits to no more than two years from the date a claim was adjudicated.
  • Prohibits pharmacy benefit managers from using extrapolation to calculate penalties or recoupments unless required by state or federal contracts.
  • Requires that findings of overpayment or underpayment be based on actual amounts rather than projections based on similar patients or orders.
  • Sets requirements for creating maximum allowable cost lists, such as ensuring drugs are rated 'A' or 'B' in the FDA's Orange Book or generally available from wholesalers.
  • Establishes a timeline for delivering preliminary audit reports within 120 days and allows pharmacies at least 30 days to respond to findings.

Who it affects

  • Pharmacy benefit managers operating in Wyoming.
  • Pharmacies that have contracts with pharmacy benefit managers.
  • The Wyoming Department of Insurance, which issues licenses and establishes rules.
  • Insurers that provide health insurance coverage in the state.

Limits and unknowns

  • The specific amount of the licensing fee is not listed in the provided text, only that a fee is required.
  • The audit rules do not apply to audits involving suspected fraudulent activity or intentional misrepresentation.
  • The audit rules do not apply to audits of claims paid for by federally funded programs.
  • The rules apply to contracts entered into, renewed, or extended on or after July 1, 2016, and to all audits of pharmacies on and after July 1, 2017.

Plain language

Terms to know

Pharmacy benefit manager
An entity that contracts with a pharmacy on behalf of an insurer or third party administrator to administer or manage prescription drug benefits.
Maximum allowable cost
The maximum amount that a pharmacy benefit manager will reimburse a pharmacist or pharmacy for the cost of a generic drug.
Audit
A review of a pharmacy's records and claims conducted by a pharmacy benefit manager to check for overpayments or underpayments.
Recoupment
The recovery of funds that were overpaid or paid in error, which must occur after the final internal disposition of the audit including the appeals process.

Official record

Sources

Source checked
Read the official summary

Summary for LSO115 Bill No.: HB0035 Effective : 7/1/2016 LSO No.: 16LSO-0191 Enrolled Act No.: HEA No. 0018 Chapter No.: 90 Prime Sponsor: Joint Corporations, Elections & Political Subdivisions Interim Committee Catch Title: Pharmacy benefit manager regulation. Subject: Regulati on of pharmacy benefit managers Summary/Major Elements: This bill regulate s pharmacy benefit managers whose job it is to manage and monitor prescription drug benefits, generally on behalf of insurance companies. The bill establishes procedures for licensing pharmacy benefit managers by the Department of Insurance. The bill regulate s audits perform ed by pharmacy benefit managers. The bill sets requirements for drug pricing and provide s and regulates the processes for pharmacies to appeal the actions of pharmacy benefit managers. The above summary is not an official publication of the Wyoming Legislature and is not an official statement of legislative intent. While the Legislative Service Office endeavored to provide accurate information in this summary, it should not be relied upon as a comprehensive abstract of the bill .

Public statements

Why lawmakers voted

Last checked Aug 7, 12:53 AM

Couldn't find a published reason.

Wyoming roll calls

Recorded votes

5 roll calls

S 3rd Reading:Passed 30-0-0-0-02016-02-29 · Senate30 yes 0 no
S07 - Corporations:Recommend Do Pass 5-0-0-0-02016-02-25 · Senate5 yes 0 no
H 3rd Reading:Passed 45-14-1-0-02016-02-18 · House45 yes 14 no
H07 - Corporations:Recommend Amend and Do Pass 8-0-1-0-02016-02-12 · House8 yes 0 no
H Introduced and Referred to H07 - Corporations 59-0-1-0-02016-02-09 · House59 yes 0 no

Official activity

Bill history

  1. Assigned Chapter NumberLSO
  2. Governor Signed HEA No. 0018Governor
  3. S President Signed HEA No. 0018Senate
  4. H Speaker Signed HEA No. 0018House
  5. Assigned Number HEA No. 0018LSO
  6. S 3rd Reading:Passed 30-0-0-0-0Senate
  7. S 2nd Reading:PassedSenate
  8. S COW:PassedSenate
  9. S Placed on General FileSenate
  10. S07 - Corporations:Recommend Do Pass 5-0-0-0-0Senate
  11. S Introduced and Referred to S07 - CorporationsSenate
  12. S Received for IntroductionSenate
  13. H 3rd Reading:Passed 45-14-1-0-0House
  14. H 2nd Reading:PassedHouse
  15. H COW:PassedHouse
  16. Amendment AdoptedHouse
  17. H Placed on General FileHouse
  18. H07 - Corporations:Recommend Amend and Do Pass 8-0-1-0-0House
  19. H Introduced and Referred to H07 - Corporations 59-0-1-0-0House
  20. H Received for IntroductionHouse

Changes

Amendments

1 stored

HB0035HS001

Adopted Standing Committee by HCorporations