Plain English Breakdown
The bill passed the legislature but has no listed effective date; enforcement depends entirely on contract dates after December 31, 2026.
SB1225: Pharmacy Rebates and Cost Sharing
This law requires pharmacy benefit managers to calculate patient costs using a drug price reduced by at least all rebates received.
What This Bill Does
- Requires cost sharing for prescription drugs to be calculated based on a price reduced by at least 100% of any rebates received.
- Prohibits pharmacy benefit managers and third-party payors from keeping rebate money or other price concessions as revenue.
- Allows these companies to lower patient costs even more than the law requires if they choose.
Who It Names or Affects
- Pharmacy benefit managers
- Third-party payors such as insurance companies
- Covered individuals who are insured or enrolled in health care plans
Terms To Know
- Cost sharing requirement
- Any copayment, coinsurance, deductible, or other amount a patient must pay for a prescription drug.
- Rebate
- Price reductions like negotiated concessions and performance-based payments, plus administration fees collected from drug makers.
Limits and Unknowns
- This law only applies to insurance contracts entered into, renewed, extended, or modified after December 31, 2026.
- The official text does not state a specific effective date for enforcement beyond the contract timeline.