Wyoming has introduced a new bill regulating pharmacy benefit managers (PBMs), specifically SF0036, also known as the Pharmacy Benefit Managers Act Enhancements “Act”, which if enacted, would amend Wyoming’s Insurance Code and increase oversight of PBMs doing business in Wyoming. The Act was passed by the Wyoming Senate on February 25, 2022 and is currently in the House for consideration.
If enacted, the Act would provide additional protections and legal rights for independent pharmacies in Wyoming by enhancing current PBM regulations. The amendments include the following provisions:
- S. 26-52-105: Requires PBMs to track, monitor and report to the Commissioner information related to pharmacy audit appeals including the number of appeals that were denied or upheld, the reasons for appeal denials, and the total amount of any cost adjustment made by a pharmacy.
- S. 26-52-106: Restricts PBMs from retroactively denying or reducing a claim or aggregate claims for drug reimbursement after the claims have been finally adjudicated. This section restricts a PBM from basing reimbursement for a drug based on patient outcomes, scores or metrics.
- S. 26-52-107: Restricts PBMs from reimbursing a pharmacy in an amount less than the national average drug acquisition cost (NADAC) at the time the drug is dispensed.
- S. 26-52-108: Restricts PBMs from imposing pharmacy accreditation standards on a pharmacy that are inconsistent with, more stringent than or in addition to applicable federal and state requirements.
- S. 26-52-109: Restricts PBMs from amending the terms of an existing contract between a PBM and pharmacy unless the change is disclosed by the PBM at least forty-five (45) days before the effective date of the change. The Act would also prohibit retaliation by PBMs against pharmacies in Wyoming. Finally, the Commissioner would be authorized to audit PBMs to ensure compliance with this section.
Under the Act, PBMs would also have substantial limits on conducting pharmacy audits. Specifically, PBM audit periods would be reduced from two (2) years to six (6) months. If passed by the Wyoming Legislature and enacted into law, the Act will limit the ability of PBMs to continue to engage in certain improper tactics that have been significant issues for independent pharmacies over the past several years.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the United States in challenging PBM audits, network access, reimbursement practices and has extensive knowledge on all aspects of the pharmacy-PBM relationship. Contact us today to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies, including Wyoming’s current PBM laws in addition to federal laws which regulate PBM conduct.
