40 Pa. Stat. § 4528

Current through Pa Acts 2024-53, 2024-56 through 2024-111
Section 4528 - Network adequacy
(a) General rule.--A PBM shall establish a reasonably adequate and accessible retail pharmacy network for the provision of prescription drugs under a health benefit plan that shall provide for convenient patient access to pharmacies within a reasonable distance from a patient's residence in accordance with the following requirements:
(1) The network may not be limited to affiliated pharmacies only.
(2) The network shall meet or exceed the requirements of 42 CFR 423.120(A) (relating to access to covered Part D drugs) or a successor regulation. If a PBM fails to comply with the requirements, it shall not be considered a violation if the PBM contracts with all retail pharmacies within the network distance standards of the health benefit plan participants.
(b)Report requirement.--Beginning April 1, 2026, and annually thereafter, a PBM shall file with the department a network adequacy report, on a form prescribed by the department, describing the PBM network and the PBM network's accessibility in this Commonwealth. The reports shall be posted on the department's publicly accessible Internet website.

40 P.S. § 4528

Added by P.L. (number not assigned at time of publication) 2024 No. 77,§ 6, eff. 11/14/2024.