Alabama § 27-45A-8 - Pharmacy Benefits Managers - Prohibited Activities Related to Covered Individuals; Exceptions.

§ 27-45A-8. Pharmacy Benefits Managers - Prohibited Activities Related to Covered Individuals; Exceptions.

(a) A pharmacy benefits manager may not do any of the following:

(1) Require a covered individual, as a condition of payment or reimbursement, to purchase pharmacist services, including, but not limited to, prescription drugs, exclusively through a mail-order pharmacy or pharmacy benefits manager affiliate.

(2) Prohibit or limit any covered individual from selecting an in-network pharmacy or pharmacist of his or her choice who meets and agrees to the terms and conditions, including reimbursements, in the pharmacy benefits manager’s contract.

(3) Impose a monetary advantage or penalty under a health benefit plan that would affect a covered individual’s choice of pharmacy among those pharmacies that have chosen to contract with the pharmacy benefits manager under the same terms and conditions, including reimbursements. For purposes of this subdivision, “monetary advantage or penalty” includes, but is not limited to, a higher copayment, a waiver of a copayment, a reduction in reimbursement services, a requirement or limit on the number of days of a drug supply for which reimbursement will be allowed, or a promotion of one participating pharmacy over another by these methods.

(4)a. Use a covered individual’s pharmacy services data collected pursuant to the provision of claims processing services for the purpose of soliciting, marketing, or referring the covered individual to a mail-order pharmacy or PBM affiliate.

b. This subdivision shall not limit a health benefit plan’s use of pharmacy services data for the purpose of administering the health benefit plan.

c. This subdivision shall not prohibit a pharmacy benefits manager from notifying a covered individual that a less costly option for a specific prescription drug is available through a mail-order pharmacy or PBM affiliate, provided the notification shall state that switching to the less costly option is not mandatory. The commissioner, by rule, may determine the language of the notification authorized under this paragraph made by a pharmacy benefits manager to a covered individual.

(5) Require a covered individual to make a payment for a prescription drug at the point of sale in an amount that exceeds the lessor of the following:

a. The contracted cost share amount.

b. An amount an individual would pay for a prescription if that individual were paying without insurance.

(6) Otherwise seek to limit, control, or influence the utilization of a pharmacy or pharmacist services by a covered individual through any of the practices of steering.

(b) If any of the practices prohibited under subsection (a), including activities that qualify as other prescription drug or device services, are required of a pharmacy benefits manager pursuant to its contractual duties under a health benefits plan, the pharmacy benefits manager shall not be subject to this section.