Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies

Last updated: May 22, 2017

Details about this bill
Category: Pharmacy Related
Status: Passed
Sponsor: Senator Geoff Gratwick, Senate 32 - York County
Session: 128
Bill #: LD 6



UPDATE: This bill has been signed by the Governor. It will take effect 90 days post-adjournment.

UPDATE 5/1/17: This bill has passed the House and is awaiting final Senate action.

UPDATE: This bill received an Ought to Pass as Amended report from the Committee. It is awaiting action in the Senate.


This bill prohibits a health insurance carrier from retroactively reducing payment on a properly submitted claim by a pharmacy provider. The bill also prohibits a carrier from charging or holding a pharmacy provider responsible for any fee related to a claim that is not apparent at the time the carrier processes the claim, that is not reported on the remittance advice or after the initial claim is adjudicated by the carrier.