340B state policy map

Arizona

Status: Final Enacted

SB 1176

Effective Date: 7/22/22
This measure applies to PBMs and third party administrators. This measure prohibits all contracts for a third party that reimbursed for 340B drugs from discriminating in reimbursement, assessing fees or clawbacks, excluding pharmacies from their network, or restricting dispensing or deliver medicines, all solely on the bases that the pharmacy dispenses 340B drugs.

Arkansas

Status: Final Enacted

HB 1881

Effective date: 7/26/21
This bill prohibits third parties restricting or placing burdens on using drugs or pharmacies from 340B or restricting choice of pharmacies or attempting to force patients to use a mail-order pharmacy. This bill amends Title 23 Chapter 92. This bill requires third parties to inform patients that they are not required to use mail-order pharmacies and obtain a signed waiver before using a mail-order pharmacy and use the formulary and coverage decisions during normal course of business. Third parties may not restrict patient's freedom to choose a pharmacy and must end any discriminatory contracting relating to drug-pricing savings and pricing that occurs when offering a lower reimbursement for drugs purchased under 340B, refusal to cover 340B drugs, refusal to permit 340B pharmacies in network, and charging more than fair market value for 340B services, or altering the formulary to exclude 340B drugs. The insurance commissioner must promulgate rules to implement this bill. This measure takes effect on July 26, 2021.

California

Status: 2nd Chamber

SB 939

This measure is applicable to pharmacy benefit managers and drug manufacturers. Under this measure, a payer may not discriminate against a covered entity or a specified pharmacy in connection with dispensing covered drugs. They also may not prevent a covered entity from retaining the benefit of discounted pricing for the purchase of covered drugs.Discrimination that is prohibited includes the following: (1) Payment terms, reimbursement methodologies, or other terms and conditions that distinguish between covered drugs and other drugs, accounting for the availability of discounts under the 340B discount drug purchasing program, or determining the reimbursement, which is less favorable than the payment terms for similar entities.(2) Terms or conditions applied to covered entities or specified pharmacies based on the dispensing of covered drugs or their status as a covered entity or specified pharmacy, including restrictions or requirements for participation in standard or preferred pharmacy networks, or requirements related to the frequency or scope of audits.(3) Requiring a covered entity or specified pharmacy to identify, either directly or through a third party, covered drugs or covered drug costs.(4) Refusing to contract with or terminating a contract with a covered entity or specified pharmacy, or otherwise excluding a covered entity or specified pharmacy from a standard or preferred network(5) Retaliation against a covered entity or specified pharmacy based on its exercise of any right or remedy under this measure.(6) Interfering with an individual’s choice to receive a covered drug from a covered entity or specified pharmacy, whether in person or via direct delivery, mail, or other forms of shipment. This will not apply to the MediCal program, or the federal Medicare program, but does apply to entities that contract with Medi-Cal or Medicare if they meet the definition of a payer and have the discretion to negotiate or establish rates of payment for drugs.

Colorado

Status: Final Enacted

HB 1122

Effective Date: 8/31/22
The measure enacts the 340B Prescription Drug Program Anti-discrimination Act, which prohibits health insurers, PBMs, and other third-party payers from discriminating against entities, including pharmacies, participating in the federal 340B drug pricing program. These third-party payers will not be able to: 1. Refuse to reimburse a 340B covered entity for dispensing 340B drugs, imposing additional requirements or restrictions on 340B covered entities, or reimbursing a 340B covered entity for a 340B drug at a rate lower than the amount paid for the same drug to pharmacies that are not 340B entities. 2. Assess fees, chargebacks, and adjustments against 340B entities, restricting a 340B covered entity's access to ta pharmacy network because it participates in the program. 3. Requiring a 340B covered entity to contract with a specific pharmacy or health coverage plan in order to access the third-party payer's pharmacy network.4. Imposing a restriction or additional charge in the patient who obtains a drug from a 340B entity.5. Restrict methods where a 340B entity may dispense or deliver the drugs. Any violation of this measure will be recognized as an unfair or deceptive act. 

Georgia

Status: Final Enacted

SB 313

Effective Date: 1/1/21
Discriminate in reimbursement, assess any fees or adjustments, or exclude a pharmacy from the pharmacy benefit manager's network on the basis that the pharmacy dispenses drugs subject to an agreement under 42 U.S.C. Section 256b.

Indiana

Status: Final Enacted

HB 1405

Effective Date: 7/01/21
This measure prohibits a pharmacy benefit manager (PBM) from: (1) imposing limits on a pharmacy's access to medication that differ from those existing for a PBM affiliate; or (2) sharing any covered individual's information, except as permitted by the federal Health Insurance Portability and Accountability Act (HIPAA). Prohibits the inclusion of certain provisions in a contract between a PBM and an entity authorized to participate in the federal 340B Drug Pricing Program, with certain exceptions. Requires a PBM: (1) to update the PBM's maximum allowable cost list at least every seven days; (2) to determine that a prescription drug is not obsolete, is generally available for purchase by pharmacies, and is not temporarily unavailable, listed on a drug shortage list, or unable to be lawfully substituted before placing the prescription drug on a maximum allowable cost list. it provides that: (1) if a PBM approves an appeal concerning maximum allowable cost pricing, the PBM must notify each pharmacy in the PBM's network that the maximum allowable cost for the drug has been adjusted; and (2) if a PBM denies an appeal, the PBM must provide the reason for the denial and other information, and the appealing pharmacy or other entity may then file a complaint with the department of insurance (department). it also allows a contracted pharmacy or pharmacy services administrative organization to file a complaint with the department if it believes that its contract with a PBM contains an unlawful contractual provision. A PBM's violation of these requirements or prohibitions is an unfair or deceptive act or practice in the business of insurance. If a party procures a policy of insurance through an online platform: (1) the party affirmatively consents to have all notices and other documents related to the policy delivered to the party electronically; and (2) other statutory prerequisites to the electronic delivery of notices do not apply

Illinois

Status: Final Enacted

HB 4595

Effective Date: 7/1/22
This measure is applicable to pharmacy benefit managers and Medicaid-managed care. Under this measure, a contract between a PBM, third party payer, and a 340B entity may not contain any provisions that: 1. Distinguishes between drugs purchased through the 340B drug discount program and other drugs when determining reimbursement or reimbursement methodologies, or contains otherwise less favorable payment terms or reimbursement methodologies for 340B entities or 340B pharmacies when compared to similarly situated non-340B entities. 2. Imposes a fee, chargeback, or rate adjustment that is not imposed on a pharmacy that is not a 340B entity. Click link to see all provisions.

Status: 1st Chamber

SB 2008

This measure is applicable to health insurers, pharmacies, and pharmacy benefit managers. PBMs are prohibited from limiting or prohibited a beneficiary from selecting a pharmacist or pharmacy of choice, or prohibit a pharmacy from participating in any given network of pharmacies. Additionally, they may not impose any restrictive conditions on 340B pharmacies not imposed on nonparticipating pharmacies. Finally, the measure sets requirements for reimbursement of dispensing fees and acquisition costs.This measure authorizes the department to reimburse a 340B pharmacy for drugs purchased under the Drug Pricing Program at an amount equal to or grater than the ceiling price plus any professional dispensing fees. Additionally, the department, a managed care organization, or a PBM may not prohibit any 340B participating pharmacy from using drugs purchased under 340B when submitting claims for reimbursement.  

Status: 1st Chamber

SB 3729

Under this measure, a contract between a PBM, third party payer, and a 340B entity may not contain any provisions that: 1. Reimburses a 340B covered entity for drugs purchased at a 340B drug discount program at a rate lower than what was paid for the same drug to pharmacies similar in a rate that are not 340B entities. 2. Imposes a fee, chargeback, or rate adjustment that is not imposed on a pharmacy that is not a 340B entity. 3. Imposes any fee, chargeback, or rate adjustment that exceeds the fee, chargeback, or rate adjustment imposed on a pharmacy that is not a 340B entity. 4. Prevents or interferes with an individual's choice to receive a prescription drug from a 340B covered entity, including the administration of the drug, whether in person or through mail order. 5. Excludes the 340B entity from a pharmacy network based on the 340B‘s participation in the 340 drug discount program. 6. Requires a 340B covered entity to use a billing modifier to indicate that the drug claim is for a drug purchased under the 340B drug discount program. 7. Prevents a 340B covered entity from using a drug purchased under the 340B drug discount program. 8. Any other provision that discriminates against a 340B covered entity. Any violation of this section by a PBM will constitute a deceptive act or practice. The Department will establish a mechanism for entities participating in the federal Drug Pricing Program under Section 340B of the federal Public Health Service Act and their contracted pharmacies to submit quarterly retrospective utilization files to the Department or its contractor for processing Medicaid drug rebate requests reflecting 340B drug dispensing to Medicaid beneficiaries or Medicaid managed care enrollees. The Department may not require entities or their contracted pharmacies to identify 340B drugs billed to Medicaid.

Maryland

Status: Final Enacted

HB 1274

Effective Date: 10/1/22
This measure applies to pharmacy benefits managers. Under this measure, PBMs are required to make formulary decisions for a pharmacy or pharmacist that participates in the 340B program based on the normal course of business and allow a beneficiary to use any pharmacy or pharmacist that they choose without regard to 340B participation. PBMs are prohibited from: Transferring 340B program savings from a pharmacy or pharmacy that participates in the 340B programOffering lower reimbursement for a prescription drug purchased under the 340B programRefusing to cover prescription drugs covered under the 340B drug plan Refusing to allow pharmacies participating in the 340B program to participate in the PBM’s network Charging more than fair market value or seeking profit sharing in exchange for services for pharmacies participating in the 340B program. Require or otherwise limit a beneficiary to use a specified mail-order pharmacy that participates in the 340B program as a condition of coverage. Impose different contract terms on pharmacies that participate in a PBM’s network based on 340B participation Impose differed fees, chargebacks, or other adjustments on pharmacies or pharmacists based on 340B participation. Modify a beneficiary’s copayment based on a pharmacy’s 340B participation. Establish network adequacy requirements based on pharmacy 340B participation Prohibit an entity authorized to participate in the 340B program from participating in the PBM’s network PBMs are prohibited from basing formulary or prescription drug coverage decisions based on the price of the drug under the 340B program or whether the dispensing pharmacy participates in the 340B program. 340B claims processed by participating pharmacies are final at the point of adjudication. "Pharmacies or pharmacists that participate in the 340B program" means a pharmacy owned or operated by a covered entity eligible to or actively participating in the 340B program or a pharmacy/pharmacist under contract with a covered entity to dispense drugs purchased under the 340B program.This measure takes effect on October 1, 2022.

Michigan

Status: Final Enacted

HB 4351

This measure amends statute relating to pharmacy benefit managers and 340B entity reimbursement. This measure provides that a PBM that reimburses a 340B entity for drugs may not reimburse the 340B entity for drugs at a rate lower than paid for the same drug to pharmacies similar in a prescription volume that are not 340B entities. 

Status: Final Enacted

HB 4352

This measure also prohibits a pharmacy or pharmacist from entering a contract with a pharmacy benefit manager that interferes with a patient’s choice to receive an eligible prescription drug from a 340B entity or a pharmacy when dispensing a 340B drug.

Status: 1st Chamber

SB 1088

This measure is applicable to pharmacy benefits managers (PBM). Existing law prohibits carriers and PBMs from requiring a claim for a drug to include a modifier or other indication that the drug is a 340B drug unless the claim is for payment by the Medicaid program. This measure removes the provision excluding Medicaid payments. 

Minnesota

Status: Final Enacted

SF 278

Effective Date: 8/1/21
This measure prohibits a pharmacy benefit manager from discriminating against a pharmacy participating in a health plan as an entity authorized to participating in the federal 340B program.

Montana

Status: Final Enacted

SB 335

Effective Date: 4/30/19
Specifically, this measure stipulates a health insurance issuer, a plan sponsor not subject to the Employee Retirement Income Security Act of 1974 or a pharmacy benefit manager may not include in a contract with a federally certified health entity provisions that allow: (1) Payment for a prescription drug to the federally certified health entity or a contract pharmacy at less than the state rate determined by surveys used to develop national average drug acquisition costs for the Centers for Medicare and Medicaid services, or, if a national average drug acquisition cost has not been calculated, a payment less than the wholesale acquisition cost, or(2) An additional fee or charge or other adjustment that is imposed only on the federally certified health entity or its contract pharmacy. A patient eligible to receive drugs under a rebate agreement may not be discriminated against through conditions imposed on a federally certified health entity or its contract pharmacy through which the patient is eligible to receive drugs. "Federally certified health entity" means a 340B covered entity.

Nebraska

Status: Final Enacted

LB 767

Effective Date: 01/01/23
This measure provides that PBM that reimburses a 340B entity or 340B contract pharmacy is subject to an agreement under the U.S code on the limitation on prices of drugs purchased by covered entities and will not reimburse the 340 B entity or 340 B contract pharmacy for the pharmacy-dispensed drug at a rate lower than what was paid for the same drug to similarly situated pharmacies that are not 34B entities or 340B contract pharmacies.

North Carolina

Status: Final Enacted

SB 257

Effective Date: 10/01/21
This measure amends North Carolina code as related to the regulation of Pharmacy Benefit Managers (PBMs). 
A contract entered into between a pharmacy benefits manager and a 340B covered entity's pharmacy, or between a pharmacy benefits manager and a 340B contract pharmacy, will not restrict access to a pharmacy network or adjust 340B drug reimbursement rates based on whether a pharmacy dispenses drugs under the 340B drug discount program or assess any additional, or vary the amount of any, fees, chargebacks, or other adjustments on the basis of a drug being dispensed under the 340B drug discount program or a pharmacy's status as a 340B covered entity or a 340B contract pharmacy. No pharmacy benefits manager making payments pursuant to a health benefit plan will discriminate against a 340B covered entity or a 340B contract pharmacy in a manner that prevents or interferes with an enrollee's choice to receive a prescription drug from an in-network 340B covered entity or an in-network 340B contract pharmacy.

North Dakota

Status: Final Enacted

HB 1492

Final Enacted: 4/21/21
This measure amends North Dakota Century Code relating to PBM discrimination against 340B entities. Prohibits PBMs from discriminating against 340B entities, or reimburse a lower dollar amount for a drug purchased under the 340B program. They must also not hold a pharmacy responsible for a fee for any step related to the claims adjudication processing network. 

Ohio

Status: Final Enacted

SB 263

Effective Date: 4/6/21
The measure provides that a contract between a health plan issuer, including a third-party administrator, and a 340B entity may not contain any of the following provisions: 1) a reimbursement rate for a prescription drug that is less than the national average drug acquisition cost rate for that drug as determined by the United States centers for Medicare and Medicaid services or a reimbursement rate that is less than the wholesale acquisition cost of the drug, 2) a dispensing fee reimbursement amount that is less than the reimbursement amount provided to a terminal distributor of dangerous drugs, 3) a fee that is not imposed on a health care provider that is not a 340B covered entity, and 4) a fee amount that exceeds the fee amount for a health care provider that is not a 340B covered entity. The measure requires that a health plan issuer, including a third-party administrator, and a 340B entity may not discriminate against a 340B covered entity in a manner that prevents or interferes with an enrollee's choice to receive a prescription drug from a 340B covered entity or its contracted pharmacies. The measure requires that a Medicaid managed care organization, a third-party administrator, and a 340B entity may not contain any of the following provisions: 1) a reimbursement rate for a prescription drug that is less than the national average drug acquisition cost rate for that drug as determined by the United States centers for Medicare and Medicaid services or a reimbursement rate that is less than the wholesale acquisition cost of the drug, 2) a fee that is not imposed on a health care provider that is not a 340B covered entity, and 3) a fee amount that exceeds the amount for a health care provider that is not a 340B covered entity. The measure requires that a Medicaid managed care organization, a third-party administrator, and a 340B entity may not discriminate against a 340B covered entity in a manner that prevents or interferes with a Medicaid recipient's choice to receive a prescription drug from a 340B covered entity or its contracted pharmacies. This measure does not specify any enforcement mechanisms.

Oregon

Status: Final Enacted

HB 2185

Effective Date: 1/1/20
The measure prohibits a PBM from reimbursing a 340B pharmacy differently than any other network pharmacy based on its status as a 340B pharmacy. Finally, the measure requires a PBM's appeal process to allow a network pharmacy a period of at least 60 days after a claim is reimbursed in which to file the appeal. The measure defines "generally available for purchase" as a drug that is available for purchase in this state by a pharmacy from a national or regional wholesaler at the time a claim for reimbursement is submitted by a network pharmacy.

Rhode Island

Status: 1st Chamber

HB 7116

Effective Date: n/a

South Dakota

Status: Final Enacted

HB 1137

Effective Date: 3/7/19
Summary: The measure prohibits a pharmacy benefit manager from discriminating against a pharmacy participating in a health plan as an entity authorized to participate under section 340B of the Public Health Service Act.

Tennessee

Status: Final Enacted

HB 1398

Effective Date: 7/1/21
This measure creates Tennessee code to (1) prohibit payers from discriminating against a 340B entity, (2) regulate pharmacy benefit manager operations regarding specialty pharmacy and allowed amounts, and (3) require health covered entities to provide certain information about covered drugs and benefits to enrollees upon request.

340B Entities
This provision applies to health insurance issuers, managed health insurance issuers, pharmacy benefits managers, and other third-party payers ("payers").
This measure prohibits payer from:
1. Reimbursing a 340B entity for pharmacy-dispensed drugs at a rate lower than the rate paid for the same drug to non-340B entities;
2. Assessing a fee, chargeback, or adjustment upon a 340B entity that is not equally assessed on non-340B entities;
3. Excluding 340B entities from its network of participating pharmacies based on criteria that is not applied to non-340B entities; or
4. Requiring a claim for a drug by a national drug code number to include a modifier to identify that the drug is 340B drug.
This measure prohibits a payer from discriminating in any way against a 340B entity that interferes with the patient's choice to receive those drugs from the 340B entity.

Utah

Status: Final Enacted

SB 140

Effective Date: 5/5/21
This measure creates Utah code to prohibit a pharmacy benefit manager from varying the amount that the insurer reimburses an FQHC based on drug or pharmacy participation in the 340B program. This measure applies to health insurers and federally qualified health centers (FQHC), which includes a contracted pharmacy or pharmacies to dispense drugs purchased through the FQHC. This measure prohibits an insurer from varying the amount that the insurer reimburses an FQHC on the basis of whether: (i) the drug is a 340B drug; or (ii) the pharmacy is a 340B entity. This does not apply to a drug reimbursed by the Medicaid program. This measure prohibits an insurer or an insurer's pharmacy service entity from, on the basis that a FQHC participates, directly or through a contractual arrangement, in the 340B drug discount program:

1. Assessing a fee, charge-back, or other adjustment on an FQHC;

2. Restricting access to the insurer's pharmacy network;

3. Requiring the FQHC to enter into a contract with a specific pharmacy to participate in the insurer's pharmacy network;

4. Creating a restriction or an additional charge on a patient who chooses to receive drugs from an FQHC; or

5. Creating any additional requirements or restrictions on the FQHC.

This measure further prohibits an insurer or its pharmacy service from requiring a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program. This measure does not outline any rule-making or enforcement mechanisms.

Vermont

Status: Final Enacted

HB 353

Effective Date: 7/1/22
This measure provides that PBMs or other third parties that reimburse a 340B covered entity may not reimburse the 340B covered entity at a rate lower than that for non-340B covered entities. This measure provides that a PBM may not prevent or interfere with a patient's choice to receive drugs from a 340B covered entity. This measure will take effect on July 1, 2022.

Virginia

Status: Final Enacted

HB 1162

This measure applies to pharmacy benefit managers and health insurance carriers.This measure will prohibit interference with a covered individual's right to choose a pharmacy or provider, based on the pharmacy or provider's status as a covered entity or contract pharmacy. The measure would prohibit the Imposition of requirements, exclusions, reimbursement terms, or other conditions on a covered entity or contract pharmacy that differ from those applied to entities or pharmacies that are not covered entities or contract pharmacies on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this section will apply to drugs with an annual estimated per-patient cost exceeding $250,000 or prohibit the identification of a 340B reimbursement request.The measure defines a "Contract pharmacy" as a pharmacy operating under contract with a 340B-covered entity to provide dispensing services to the 340B-covered entity. The measure defines a "Covered entity" as an entity described in § 340B(a)(4) of the federal Public Health Service Act, 42 U.S.C. § 256B(a)(4).This measure defines "Covered Entity" as an entity described in section 340B of the federal Public Health Service Act, this will not include a hospital. 

West Virginia

Status: Final Enacted

HB 4112

Effective Date: 6/10/22
This measure applies to pharmacy benefit managers. Under this measure, it is considered discriminatory practice for a PBM to place additional requirements or restrictions on 340B entities resulting in administrative costs or fees that are not placed on other pharmacies or requiring claims for drugs to include modifiers or resubmitted to indicate that the drug is a 340B drug. 

Wisconsin

Status: 1st Chamber

AB 550

This bill prevents anyone (including PBMs) from reimbursing certain covered entities (federally qualified health centers, critical access hospitals, and grantees under the federal Ryan White HIV/AIDS program) at a lower rate than pharmacies at a similar level of volume based on participation in the 340B federal drug pricing program. It also prevents fees or charge backs assessed against those entities.