Mia Bonta

Existing law requires a pharmacy benefit manager engaging in business with a health care service plan or health insurer to secure a license from the Department of Managed Health Care on or after January 1, 2027, or the date on which the department has established the licensure process, whichever is later. Existing law requires a complaint about a pharmacy benefit manager to be considered as a complaint against the contracting health care service plan and authorizes it to be considered a complaint against the contracting health insurer.

Existing law requires the Department of Health Care Access and Information to establish a Health Care Payments Data Program to collect information regarding health care costs, utilization, quality, and equity. Existing law requires a pharmacy benefit manager to provide specified information to the Department of Health Care Access and Information for inclusion in the program and requires the department to include specified information in an annual analysis. Existing law also requires the Department of Health Care Access and Information to notify the Department of Managed Health Care or the Department of Insurance, as appropriate, if a health care service plan or health insurer fails to comply with specified requirements and requires those departments to take appropriate action.

This bill would require the Department of Health Care Access and Information to include data regarding pricing and payments related to prescription drugs in its annual analysis upon completion of specified regulations and to notify the Department of Managed Health Care if a pharmacy benefit manager fails to comply with specified requirements, and would require the Department of Managed Health Care to take appropriate action. The bill would require the Department of Managed Health Care to post on its internet website links to analyses and reporting published by the Department of Health Care Access and Information.