Pharmacy services; prohibit insurers and PBMs from requiring persons to obtain exclusively through pharmacies that they own.

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To: State Affairs
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Newman

HOUSE BILL NO. 558

AN ACT TO PROHIBIT HEALTH INSURERS AND PHARMACY BENEFIT 1
MANAGERS FROM REQUIRING COVERED INDIVIDUALS TO PURCHASE OR 2
OTHERWISE OBTAIN PHARMACY SERVICES EXCLUSIVELY THROUGH A PHARMACY 3
IN WHICH THE HEALTH INSURER OR PHARMACY BENEFITS MANAGER HAS AN 4
OWNERSHIP INTEREST; TO PROHIBIT HEALTH INSURERS AND PHARMACY 5
BENEFIT MANAGERS FROM OFFERING OR IMPLEMENTING HEALTH BENEFIT PLAN 6
DESIGNS THAT INCREASE PLAN OR PATIENT COSTS FOR PHARMACY SERVICES 7
IF THE COVERED INDIVIDUAL CHOOSES NOT TO USE A PHARMACY IN WHICH 8
THE HEALTH INSURER OR PHARMACY BENEFITS MANAGER HAS AN OWNERSHIP 9
INTEREST FOR THOSE PHARMACY SERVICES; TO PROHIBIT HEALTH INSURERS 10
AND PHARMACY BENEFIT MANAGERS FROM REIMBURSING A PHARMACY OR 11
PHARMACIST FOR COVERED PHARMACY SERVICES AN AMOUNT LESS THAN THE 12
AMOUNT THAT THE HEALTH INSURER OR PHARMACY BENEFITS MANAGER 13
REIMBURSES A PHARMACY IN WHICH THE HEALTH INSURER OR PHARMACY 14
BENEFITS MANAGER HAS AN OWNERSHIP INTEREST FOR PROVIDING THE SAME 15
COVERED SERVICES; TO PROHIBIT HEALTH INSURERS AND PHARMACY BENEFIT 16
MANAGERS FROM DENYING A PHARMACY THE OPPORTUNITY TO PARTICIPATE IN 17
ANY PHARMACY NETWORK AT PREFERRED PARTICIPATION STATUS IF THE 18
PHARMACY IS WILLING TO ACCEPT THE TERMS AND CONDITIONS THAT THE 19
HEALTH INSURER OR PHARMACY BENEFIT MANAGER HAS ESTABLISHED FOR 20
OTHER PHARMACIES AS A CONDITION OF PREFERRED NETWORK PARTICIPATION 21
STATUS; TO BRING FORWARD SECTION 83-9-6, MISSISSIPPI CODE OF 1972, 22
WHICH PROVIDES FOR FREEDOM OF CHOICE FOR PHARMACY SERVICES, FOR 23
THE PURPOSE OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES. 24
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 25
SECTION 1. (1) As used in this section, the following terms 26
shall have the meanings as defined in this subsection unless the 27
context clearly indicates otherwise: 28
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(a) "Covered individual" means a policyholder, 29
subscriber, enrollee or other individual participating in a health 30
benefit plan. 31
(b) "Health benefit plan" means any entity or program 32
that provides reimbursement for pharmacy services. 33
(c) "Health insurer" means any entity that provides or 34
offers a health benefit plan. 35
(d) "Pharmacy benefit manager" has meaning as defined 36
in Section 73-21-179. 37
(2) Health insurers and pharmacy benefit managers shall not 38
require a covered individual, as a condition of payment or 39
reimbursement, to purchase or otherwise obtain pharmacy services, 40
including, but not limited to, all regular prescription drugs and 41
specialty drugs regardless of day supply, exclusively through a 42
pharmacy in which the health insurer or pharmacy benefits manager 43
has an ownership interest. 44
(3) Health insurers and pharmacy benefit managers shall not 45
offer or implement health benefit plan designs that increase plan 46
or patient costs for pharmacy services, including, but not limited 47
to, variations in premiums, deductibles, copayments or 48
coinsurance, if the covered individual chooses not to use a 49
pharmacy in which the health insurer or pharmacy benefits manager 50
has an ownership interest for those pharmacy services. The 51
prohibition in this subsection includes requiring a covered 52
individual to pay the full cost or a higher cost for a 53
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prescription drug or other pharmacy services when the covered 54
individual chooses not to use a pharmacy in which the health 55
insurer or pharmacy benefits manager has an ownership interest. 56
(4) Health insurers and pharmacy benefit managers shall not 57
reimburse a pharmacy or pharmacist in the state for covered 58
pharmacy services an amount less than the amount that the health 59
insurer or pharmacy benefits manager reimburses a pharmacy in 60
which the health insurer or pharmacy benefits manager has an 61
ownership interest for providing the same covered services. 62
(5) Health insurers and pharmacy benefit managers shall not 63
deny a pharmacy the opportunity to participate in any pharmacy 64
network at preferred participation status if the pharmacy is 65
willing to accept the terms and conditions that the health insurer 66
or pharmacy benefit manager has established for other pharmacies 67
as a condition of preferred network participation status. 68
SECTION 2. Section 83-9-6, Mississippi Code of 1972, is 69
brought forward as follows: 70
83-9-6. (1) This section shall apply to all health benefit 71
plans providing pharmaceutical services benefits, including 72
prescription drugs, to any resident of Mississippi. This section 73
shall also apply to insurance companies and health maintenance 74
organizations that provide or administer coverages and benefits 75
for prescription drugs. This section shall not apply to any 76
entity that has its own facility, employs or contracts with 77
physicians, pharmacists, nurses and other health care personnel, 78
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and that dispenses prescription drugs from its own pharmacy to its 79
employees and dependents enrolled in its health benefit plan; but 80
this section shall apply to an entity otherwise excluded that 81
contracts with an outside pharmacy or group of pharmacies to 82
provide prescription drugs and services. 83
(2) As used in this section: 84
(a) "Copayment" means a type of cost sharing whereby 85
insured or covered persons pay a specified predetermined amount 86
per unit of service with their insurer paying the remainder of the 87
charge. The copayment is incurred at the time the service is 88
used. The copayment may be a fixed or variable amount. 89
(b) "Contract provider" means a pharmacy granted the 90
right to provide prescription drugs and pharmacy services 91
according to the terms of the insurer. 92
(c) "Health benefit plan" means any entity or program 93
that provides reimbursement for pharmaceutical services. 94
(d) "Insurer" means any entity that provides or offers 95
a health benefit plan. 96
(e) "Pharmacist" means a pharmacist licensed by the 97
Mississippi State Board of Pharmacy. 98
(f) "Pharmacy" means a place licensed by the 99
Mississippi State Board of Pharmacy. 100
(3) A health insurance plan, policy, employee benefit plan 101
or health maintenance organization may not: 102
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(a) Prohibit or limit any person who is a participant 103
or beneficiary of the policy or plan from selecting a pharmacy or 104
pharmacist of his choice who has agreed to participate in the plan 105
according to the terms offered by the insurer; 106
(b) Deny a pharmacy or pharmacist the right to 107
participate as a contract provider under the policy or plan if the 108
pharmacy or pharmacist agrees to provide pharmacy services, 109
including but not limited to prescription drugs, that meet the 110
terms and requirements set forth by the insurer under the policy 111
or plan and agrees to the terms of reimbursement set forth by the 112
insurer; 113
(c) Impose upon a beneficiary of pharmacy services 114
under a health benefit plan any copayment, fee or condition that 115
is not equally imposed upon all beneficiaries in the same benefit 116
category, class or copayment level under the health benefit plan 117
when receiving services from a contract provider; 118
(d) Impose a monetary advantage or penalty under a 119
health benefit plan that would affect a beneficiary's choice among 120
those pharmacies or pharmacists who have agreed to participate in 121
the plan according to the terms offered by the insurer. Monetary 122
advantage or penalty includes higher copayment, a reduction in 123
reimbursement for services, or promotion of one participating 124
pharmacy over another by these methods; 125
(e) Reduce allowable reimbursement for pharmacy 126
services to a beneficiary under a health benefit plan because the 127
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beneficiary selects a pharmacy of his or her choice, so long as 128
that pharmacy has enrolled with the health benefit plan under the 129
terms offered to all pharmacies in the plan coverage area; 130
(f) Require a beneficiary, as a condition of payment or 131
reimbursement, to purchase pharmacy services, including 132
prescription drugs, exclusively through a mail-order pharmacy; or 133
(g) Impose upon a beneficiary any copayment, amount of 134
reimbursement, number of days of a drug supply for which 135
reimbursement will be allowed, or any other payment or condition 136
relating to purchasing pharmacy services from any pharmacy, 137
including prescription drugs, that is more costly or more 138
restrictive than that which would be imposed upon the beneficiary 139
if such services were purchased from a mail-order pharmacy or any 140
other pharmacy that is willing to provide the same services or 141
products for the same cost and copayment as any mail order 142
service. 143
(4) A pharmacy, by or through a pharmacist acting on its 144
behalf as its employee, agent or owner, may not waive, discount, 145
rebate or distort a copayment of any insurer, policy or plan or a 146
beneficiary's coinsurance portion of a prescription drug coverage 147
or reimbursement and if a pharmacy, by or through a pharmacist's 148
acting on its behalf as its employee, agent or owner, provides a 149
pharmacy service to an enrollee of a health benefit plan that 150
meets the terms and requirements of the insurer under a health 151
benefit plan, the pharmacy shall provide its pharmacy services to 152
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all enrollees of that health benefit plan on the same terms and 153
requirements of the insurer. A violation of this subsection shall 154
be a violation of the Pharmacy Practice Act subjecting the 155
pharmacist as a licensee to disciplinary authority of the State 156
Board of Pharmacy. 157
(5) If a health benefit plan providing reimbursement to 158
Mississippi residents for prescription drugs restricts pharmacy 159
participation, the entity providing the health benefit plan shall 160
notify, in writing, all pharmacies within the geographical 161
coverage area of the health benefit plan, and offer to the 162
pharmacies the opportunity to participate in the health benefit 163
plan at least sixty (60) days before the effective date of the 164
plan or before July 1, 1995, whichever comes first. All 165
pharmacies in the geographical coverage area of the plan shall be 166
eligible to participate under identical reimbursement terms for 167
providing pharmacy services, including prescription drugs. The 168
entity providing the health benefit plan shall, through reasonable 169
means, on a timely basis and on regular intervals, inform the 170
beneficiaries of the plan of the names and locations of pharmacies 171
that are participating in the plan as providers of pharmacy 172
services and prescription drugs. Additionally, participating 173
pharmacies shall be entitled to announce their participation to 174
their customers through a means acceptable to the pharmacy and the 175
entity providing the health benefit plans. The pharmacy 176
notification provisions of this section shall not apply when an 177
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ST: Pharmacy services; prohibit insurers and
PBMs from requiring persons to obtain
exclusively through pharmacies that they own.
individual or group is enrolled, but when the plan enters a 178
particular county of the state. 179
(6) A violation of this section creates a civil cause of 180
action for injunctive relief in favor of any person or pharmacy 181
aggrieved by the violation. 182
(7) The Commissioner of Insurance shall not approve any 183
health benefit plan providing pharmaceutical services which does 184
not conform to this section. 185
(8) Any provision in a health benefit plan which is 186
executed, delivered or renewed, or otherwise contracted for in 187
this state that is contrary to this section shall, to the extent 188
of the conflict, be void. 189
(9) It is a violation of this section for any insurer or any 190
person to provide any health benefit plan providing for 191
pharmaceutical services to residents of this state that does not 192
conform to this section. 193
SECTION 3. This act shall take effect and be in force from 194
and after July 1, 2026. 195