This bill aims to further regulate the practice of pharmacy benefits managers (PBMs) in Alabama. PBMs are intermediaries between insurers and pharmacies that manage prescription drug benefits on behalf of health insurance providers. The bill proposes an amendment to several sections of the Alabama Code 1975 in relation to PBMs, with several key caveats: – It prohibits PBMs from reimbursing pharmacies less than the actual drug acquisition cost and from paying less to pharmacies than what is reimbursed by third-party payors (insurance companies or entities that pay medical claims on behalf of patients). – It enables pharmacists to communicate drug prices with individuals covered in the plan. – It prevents PBMs from charging pharmacies certain fees or investigating pharmacists for fraud, waste, or abuse without reasonable suspicion. – It demands that PBMs report rebate amounts to the Commissioner of Insurance and third-party payors. – It allows the examination of PBMs by the Commissioner of Insurance. – It obligates PBMs to pass on 100 percent of rebates received from pharmaceutical manufacturers to third-party payors, and prevents them from penalising the latter for switching PBMs. – It rules that an enquiry into fraud, waste, or abuse by a PBM falls under the Pharmacy Audit Integrity Act. 

This bill proposes to eliminate the Certificate of Need program in Alabama, a program that requires health care providers to have state approval before they can offer certain new or expanded services. The bill also proposes to abolish several health-related organizations, including the State Health Planning and Development Agency, the Statewide Health Coordinating Council, the Health Care Information and Data Advisory Council, and the Certificate of Need Review Board. Furthermore, the bill includes provisions to update the existing code language related to these entities and the certificate program to reflect the proposed changes. If passed, the changes would take effect on October 1, 2024.

This bill exempts health care institutions and services located in rural areas from the requirement to obtain a certificate of need. Specifically, the bill amends the definition of “covered health care reporter” to include health care facilities in rural areas, and adds a new section that states any new institutional health service proposed to be offered or developed in a rural area on or after October 1, 2024 shall not be subject to certificate of need review. The bill also repeals a section related to an exemption for certain kidney disease treatment centers, and sets an effective date of October 1, 2024.

Relating to health insurance; to allow health insurers to communicate with enrollees regarding their health insurance plan or policy by electronic means.

Relating to health insurance; to allow health insurers to communicate with enrollees regarding their health insurance plan or policy by electronic means.

Relating to Medicaid; to expand the program to provide assistance to certain state residents; to direct the Alabama Medicaid Agency to implement the expansion; to direct other state agencies and entities to provide certain assistance; and to provide for appropriations for adequate funding.

Relating to pharmacists and the dispensing of emergency refills of medication; to amend Section 34-33-75 of the Code of Alabama 1975, to increase the supply of medication that may be dispensed in a one-time emergency refill to include the smallest dispensable package size of a medication; and to further provide for the notice to the prescriber after dispensing.