Patient and Provider Protection Act regulates pharmacy benefits managers' practices.
The Patient and Provider Protection Act sets requirements for pharmacy benefits managers, including a fiduciary duty to act in the best interests of carriers. It prohibits misleading marketing and mandates equal reimbursement rates for all contracted pharmacies. The act also stipulates that contracts conditioning rebates on excluding generic drugs are invalid. Pharmacy and therapeutics committees must ensure no decision favors higher-cost drugs over generics. The act presumes commercial market plan contracts to be contracts of adhesion, subjecting them to special scrutiny in disputes.
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- Overview
- Core Provisions
- Implementation
- Impact
- Legal Framework
- Critical Issues
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