General Provisions
Cal. INS § 10125.2
California Statutes
(
a) A pharmacy benefit manager that contracts with a health insurer shall comply with
Article 6.1 (commencing with
Section 1385.001) of
Chapter 2.2 of Division of the Health and Safety Code, including Sections 1385.004 and 1385.006 of the Health and Safety Code. (
b) A complaint made by an insured that includes potential violations by a pharmacy benefit manager of the terms of
Article 6.1 (commencing with
Section 1385.001) of
Chapter 2.2 of Division of the Health and Safety Code may be considered by the department to be a complaint against the health insurer. (
c) If a health insurer delegates functions to a pharmacy benefit manager, the pharmacy benefits manager shall comply with this code, as applicable. A health insurer shall specify by contract the pharmacy benefits manager’s responsibilities and shall monitor the pharmacy benefit manager to ensure compliance with this code. Notwithstanding delegation pursuant to this subdivision, the health insurer shall remain responsible for compliance with this code. (
d) A contract between a health insurer and a pharmacy benefit manager issued, amended, or renewed on or after January 1, 2027, or the date on which the Department of Managed Health Care has established the pharmacy benefit manager licensure process, whichever is later, shall require the pharmacy benefit manager to be licensed and in good standing with the Department of Managed Health Care. A contract term that violates
Article 6.1 (commencing with
Section 1385.001) of
Chapter 2.2 of Division of the Health and Safety Code shall be void on and after January 1, 2029. (
e) The department may issue guidance regarding implementation of, and compliance with, this
section and Sections 10125.2, 10123.2045, and 10123.205. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with
Section 1340) of Part of Division of Title of the Government Code), until January 1, 2030. The department shall consult with stakeholders in developing guidance pursuant to this subdivision.