ARTICLE 6.1. Pharmacy Benefit Managers

Heading of Article 6.1 amended by Stats. 2025, Ch. 21, Sec. 9.

§§ 1385.001–1385.009 · 32 sections

§ 1385.001 For the purposes of this article: (a) “Affiliated entity” means any of the following: (1) An applicable group purchasing organization, drug manufacturer,…
§ 1385.0010 In addition to the requirements of Section 1385.009, and upon request of the director, an application shall be accompanied by authorization for disclosure to…
§ 1385.0011 (a) A pharmacy benefit manager shall submit to the department financial statements prepared as of the close of its fiscal year within 120 days after the close…
§ 1385.0012 (a) A pharmacy benefit manager licensed pursuant to this article shall submit to the Department of Health Care Access and Information all information required…
§ 1385.0013 (a) (1) A licensed pharmacy benefit manager shall, within 30 days after a change in the information contained in its application, other than financial or…
§ 1385.0014 Upon denial of an application for licensure, or the issuance of an order pursuant to Section 1385.0013 disapproving, suspending, or postponing a material…
§ 1385.0015 A pharmacy benefit manager license issued under this article shall remain in effect until revoked or suspended by the director.
§ 1385.0016 (a) A pharmacy benefit manager applying for licensure under this article shall reimburse the director for the actual cost of processing the application,…
§ 1385.0017 (a) To support the department in the administration of this article and the effective regulation of pharmacy benefit managers under this chapter, and to…
§ 1385.0018 (a) The director may, after appropriate notice and opportunity for a hearing, by order suspend or revoke a license issued under this article to a pharmacy…
§ 1385.0019 (a) A pharmacy benefit manager whose license has been revoked, or suspended for more than one year, may petition the director to reinstate the license as…
§ 1385.002 (a) The department has the authority to enforce the provisions of this article, including the authority to adopt, amend, or repeal any rules and regulations,…
§ 1385.0020 (a) Surrender of a pharmacy benefit manager license shall become effective 30 days after receipt of an application to surrender the license or within a shorter…
§ 1385.0021 (a) Notwithstanding the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code), the director is not…
§ 1385.0022 A pharmacy benefit manager has a fiduciary duty to its payer client that includes a duty to be fair and truthful toward the payer, to act in the payer’s best…
§ 1385.0023 (a) The department may conduct periodic routine and nonroutine surveys of a pharmacy benefit manager. These surveys shall be conducted in accordance with…
§ 1385.0024 (a) The Pharmacy Benefit Manager Administrative Fines and Penalties Fund is hereby created in the State Treasury. (b) On and after July 1, 2025, the fines and…
§ 1385.0025 The provisions of this article are severable. If any provision of this article or its application is held invalid, that invalidity shall not affect other…
§ 1385.0026 (a) A pharmacy benefit manager shall not impose any requirements, conditions, or exclusions that discriminate against a nonaffiliated pharmacy in connection…
§ 1385.0027 A pharmacy benefit manager shall not do any of the following: (a) Require a plan participant to use only an affiliated pharmacy if there are nonaffiliated…
§ 1385.0028 (a) A contract issued, amended, or renewed on or after January 1, 2026, between a nonaffiliated pharmacy and a pharmacy benefit manager shall not prohibit the…
§ 1385.0029 (a) A pharmacy benefit manager shall not derive income from pharmacy benefit management services provided to a payer in this state except for income derived…
§ 1385.003 (a) A health care service plan shall disclose to a contracted pharmacy provider or its contracting agent the prescription drug information contained in…
§ 1385.0031 Commencing January 1, 2026, a pharmacy benefit manager shall not conduct spread pricing in this state. If a preexisting contract between a pharmacy benefit…
§ 1385.0032 (a) Notwithstanding any other law, a pharmacy benefit manager shall not enter into, amend, enforce, or renew a contract on or after January 1, 2026, with…
§ 1385.0033 (a) A person that violates this article shall be subject to an injunction and liable for a civil penalty of not less than one thousand dollars ($1,000) or more…
§ 1385.0034 This article does not apply to a collectively bargained Taft-Hartley self-insured prescription drug plan offered pursuant to the federal Employee Retirement…
§ 1385.004 (a) A health care service plan that contracts with a pharmacy benefit manager for management of any or all of its prescription drug coverage shall require the…
§ 1385.005 (a) A pharmacy benefit manager required to register with the department pursuant to Section 1385.004 shall complete an application for registration with the…
§ 1385.006 The failure by a health care service plan to comply with the contractual requirements and to maintain appropriate oversight of a contracted pharmacy benefit…
§ 1385.008 On or after January 1, 2027, or the date on which the department has established the licensure process pursuant to Section 1385.009, whichever is later, a…
§ 1385.009 An application for licensure as a pharmacy benefit manager under this article shall be verified by an authorized representative of the applicant and shall be…