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PBM Registration/Generic Drug Pricing Transparency/Pharmacy Audit Integrity/PACE Reimbursement

  • Requires Pharmacy Benefit Managers (PBMs) to register with the Department of Insurance; (Effective February 19, 2017)

  • Provides for greater transparency in the establishment and management of multiple source generic lists to pharmacies; (Effective May 20, 2017)

  • Provides for uniform and fair standards in the auditing of pharmacy claims (Effective May 20, 2017); and

  • Rebalances PACE reimbursement to National Average Drug Acquisition Cost (NADAC) + a $13 professional dispensing fee or Wholesale Acquisition Cost (WAC) +3.2% (when NADAC is not available). (Effective November 21, 2016)

Summary of Key Provisions
  • A summary of the key provisions of Act 169 of 2016 can be found here.
Link to Full Act
Issue Videos
  • Why Oversight is Needed for Pharmacy Benefit Managers "PBMs"
  • Maximum Allowable Cost Pricing or MAC Pricing on Pharmacies 
  • Uniform and Fair Auditing Standards of Pharmacy Claims in PA


Please contact Don Smith at (717) 234-6151, ext. 102 or dsmith@papharmacists.com with any questions.

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