HB1580 (2022) Detail

Relative to pharmacy benefits managers.


HB 1580-FN - AS INTRODUCED

 

 

2022 SESSION

22-2448

11/10

 

HOUSE BILL 1580-FN

 

AN ACT relative to pharmacy benefits managers.

 

SPONSORS: Rep. DeLemus, Straf. 24

 

COMMITTEE: Commerce and Consumer Affairs

 

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ANALYSIS

 

This bill establishes the licensure of pharmacy benefits managers.

 

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

22-2448

11/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty Two

 

AN ACT relative to pharmacy benefits managers.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  Pharmacy Benefits Managers.  RSA 402-N is repealed and reenacted to read as follows:

402-N:1  Scope.  This chapter applies to any audit of the records of a pharmacy conducted by a managed care company, third-party payer, pharmacy benefits manager or an entity that represents a covered entity, or health benefit plan, the registration of auditing entities, and the licensure and regulation of pharmacy benefits managers.

402-N:2  Definitions.

I.  "340B entity" means an entity participating in the federal 340B drug discount program, as described in 42 U.S.C. section 256b, including its pharmacy or pharmacies, or any pharmacy or pharmacies, contracted with the participating entity to dispense drugs purchased through such program.

II.  "Affiliate" means a pharmacy, pharmacist, or pharmacy technician which, either directly or indirectly through one or more intermediaries:

(a) Has an investment or ownership interest in a pharmacy benefits manager licensed under this chapter;

(b)  Shares common ownership with a pharmacy benefits manager licensed under this chapter; or

(c)  Has an investor or ownership interest holder which is a pharmacy benefits manager licensed under this chapter.

III.  "Auditing entity" means a person or company that performs a pharmacy audit, including a covered entity, pharmacy benefits manager, managed care organization, or third-party administrator.

IV.  "Business day" means any day of the week excluding Saturday, Sunday, and any legal holiday.

V.  "Claim level information" means data submitted by a pharmacy or required by a payer or claims processor to adjudicate a claim.

VI.  "Commissioner" means the commissioner of the department of insurance.

VII.  "Covered entity" means a contract holder or policy holder providing pharmacy benefits to a covered individual under a health insurance policy pursuant to a contract administered by a pharmacy benefits manager and may include a health benefit plan.

VIII.  "Covered individual" means a member, participant, enrollee, or beneficiary of a covered entity who is provided health coverage by a covered entity, including a dependent or other person provided health coverage through the policy or contract of a covered individual.

IX.  "Extrapolation" means the practice of inferring a frequency of dollar amount of overpayments, underpayments, nonvalid claims, or other errors on any portion of claims submitted, based on the frequency of dollar amount of overpayments, underpayments, nonvalid claims, or other errors actually measured in a sample of claims.

X.  "Defined cost sharing" means a deductible payment or coinsurance amount imposed on an enrollee for a covered prescription drug under the enrollee's health plan.

XI.  "Health benefit plan" or "health plan" means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

XII.  "Health care provider" means a person, partnership, corporation, facility, or institution licensed or certified, in this or any other state, to provide health care or professional health care services, including but not limited to a physician, osteopathic physician, hospital, dentist, registered or licensed practical nurse, optometrist, pharmacist, podiatrist, chiropractor, physical therapist, or psychologist.

XIII.  "Health insurance policy" means a policy, subscriber contract, certificate, or plan that provides prescription drug coverage.  The term includes both comprehensive and limited benefit health insurance policies.

XIV.  "Insurance commissioner" or "commissioner" means the commissioner of the insurance department.

XV.  "Network" means a pharmacy or group of pharmacies that agree to provide prescription services to covered individuals on behalf of a covered entity or group of covered entities in exchange for payment for its services by a pharmacy benefits manager or pharmacy services administration organization.  The term includes a pharmacy that generally dispenses outpatient prescriptions to covered individuals or dispenses particular types of prescriptions, provides pharmacy services to particular types of covered individuals or dispenses prescriptions in particular health care settings, including networks of specialty, institutional or long-term care facilities.

XVI.  "Maximum allowable cost" means the per unit amount that a pharmacy benefits manager reimburses a pharmacist for a prescription drug, excluding dispensing fees and copayments, coinsurance, or other cost-sharing charges, if any.

XVII.  "National average drug acquisition cost" means the monthly survey of retail pharmacies conducted by the federal Centers for Medicare and Medicaid Services to determine average acquisition cost for Medicaid covered outpatient drugs.

XVIII.  "Nonproprietary drug" means a drug containing any quantity of any controlled substance or any drug which is required by any applicable federal or state law to be dispensed only by prescription.

XIX.  "Pharmacist" means an individual licensed by New Hampshire to engage in the practice of pharmacy.

XX.  "Pharmacy" means any place within this state where drugs are dispensed and pharmacist care is provided.

XXI.  "Pharmacy audit" means an audit, conducted on-site by or on behalf of an auditing entity of any records of a pharmacy for prescription or nonproprietary drugs dispensed by a pharmacy to a covered individual.

XXII.  "Pharmacy benefits management" means the performance of any of the following:

(a)  The procurement of prescription drugs at a negotiated contracted rate for dispensation within the state of New Hampshire to covered individuals;

(b)  The administration or management of prescription drug benefits provided by a covered entity for the benefit of covered individuals; or

(c)  The administration of pharmacy benefits, including:

(1)  Operating a mail-service pharmacy;

(2)  Claims processing;

(3)  Managing a retail pharmacy network;

(4)  Paying claims to a pharmacy for prescription drugs dispensed to covered individuals via retail or mail-order pharmacy;

(5)  Developing and managing a clinical formulary including utilization management and quality assurance programs;

(6)  Rebate contracting administration; and

(7)  Managing a patient compliance, therapeutic intervention, and generic substitution program.

XXIII.  "Pharmacy benefits manager" means a person, business, or other entity that performs pharmacy benefits management for covered entities.

XXIV.  "Pharmacy record" means any record stored electronically or as a hard copy by a pharmacy that relates to the provision of prescription or nonproprietary drugs or pharmacy services or other component of pharmacist care that is included in the practice of pharmacy.

XXV.  "Pharmacy services administration organization" means any entity that contracts with a pharmacy to assist with third-party payer interactions and that may provide a variety of other administrative services, including contracting with pharmacy benefits managers on behalf of pharmacies and managing pharmacies' claims payments from third-party payers.

XXVI.  "Point-of-sale fee" means all or a portion of a drug reimbursement to a pharmacy or other dispenser withheld at the time of adjudication of a claim for any reason.

XXVII.  "Rebate" means any and all payments that accrue to a pharmacy benefits manager or its health plan client, directly or indirectly, from a pharmaceutical manufacturer, including, but not limited to, discounts, administration fees, credits, incentives, or penalties associated directly or indirectly in any way with claims administered on behalf of a health plan client.

XXVIII.  "Retroactive fee" means all or a portion of a drug reimbursement to a pharmacy or other dispenser recouped or reduced following adjudication of a claim for any reason, except as otherwise permissible as described in this article.

XXIX.  "Third party" means any insurer, health benefit plan for employees which provides a pharmacy benefits plan, a participating public agency which provides a system of health insurance for public employees, their dependents and retirees, or any other insurer or organization that provides health coverage, benefits, or coverage of prescription drugs as part of workers' compensation insurance in accordance with state or federal law.  The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

402-N:3  Licensure of Pharmacy Benefit Managers.

I.  A person or organization may not establish or operate as a pharmacy benefits manager in the state of New Hampshire without first obtaining a license from the commissioner pursuant to this section.  The commissioner shall make an application form available on its publicly accessible Internet website that includes a request for the following information:

(a)  The identity, address, and telephone number of the applicant;

(b)  The name, business address, and telephone number of the contact person for the applicant;

(c)  When applicable, the federal employer identification number for the applicant; and

(d)  Any other information the commissioner considers necessary and appropriate to establish the qualifications to receive a license as a pharmacy benefit manager to complete the licensure process, as set forth in administrative rules adopted by the commissioner pursuant to RSA 541-A.

II.  Term and fee.

(a)  The term of licensure shall be 2 years from the date of issuance.

(b)  The commissioner shall determine the amount of the initial application fee and the renewal application fee for the registration.  The fee shall be submitted by the applicant with an application for registration.  An initial application fee is nonrefundable.  A renewal application fee shall be returned if the renewal of the registration is not granted.

(c)  The amount of the initial application fees and renewal application fees must be sufficient to fund the commissioner's duties in relation to his/her responsibilities under this chapter.

(d)  Each application for a license, and subsequent renewal for a license, shall be accompanied by evidence of financial responsibility in an amount of $1 million.

III.  Licensure.

(a)  The commissioner shall adopt administrative rules pursuant to RSA 541-A establishing the licensing, fees, application, financial standards, and reporting requirements of pharmacy benefit managers.

(b)  Upon receipt of a completed application, evidence of financial responsibility, and fee, the commissioner shall make a review of each applicant and shall issue a license if the applicant is qualified in accordance with the provisions of this section and the rules adopted by the commissioner pursuant to this section.  The commissioner may require additional information or submissions from an applicant and may obtain any documents or information reasonably necessary to verify the information contained in the application.

(c)  The license may be in paper or electronic form, is nontransferable, and shall prominently list the expiration date of the license.

(d)  Network adequacy.

(1)  A pharmacy benefit manager's network shall be reasonably adequate, shall provide for convenient patient access to pharmacies within a reasonable distance from a patient's residence and shall not be comprised only of mail-order benefits but must have a mix of mail order benefits and physical stores in this state.

(2) A pharmacy benefit manager shall provide a pharmacy benefit manager's network report describing the pharmacy benefit manager's network and the mix of mail-order to physical stores in this state in a time and manner required by rule adopted by the commissioner pursuant to this section.

(3)  Failure to provide a timely report may result in the suspension or revocation of a pharmacy benefit manager's license by the commissioner.

(e)  Enforcement.

(1)  The commissioner shall enforce this section and may examine or audit the books and records of a pharmacy benefit manager providing pharmacy benefits management to determine if the pharmacy benefit manager is in compliance with this section.  Provided, that any information or data acquired during the examination or audit is considered proprietary and confidential and exempt from disclosure under RSA 91-A.

(2)  The commissioner shall adopt administrative rules regulating pharmacy benefit managers in a manner consistent with this chapter.  Rules adopted pursuant to this section shall set forth penalties or fines, including, without limitation, monetary fines, suspension of licensure, and revocation of licensure for violations of this chapter and the rules adopted pursuant to this section.

(f)  Applicability.  This section is applicable to any contract or health benefit plan issued, renewed, recredentialed, amended, or extended on or after July 1, 2022.

402-N:4  Regulation of Pharmacy Benefit Managers.

I.  A pharmacy, a pharmacist, and a pharmacy technician shall have the right to provide a covered individual with information related to lower cost alternatives and cost share for the covered individual to assist health care consumers in making informed decisions.  Neither a pharmacy, a pharmacist, nor a pharmacy technician may be penalized by a pharmacy benefit manager for discussing information in this section or for selling a lower cost alternative to a covered individual, if one is available, without using a health insurance policy.

II.  A pharmacy benefit manager may not collect from a pharmacy, a pharmacist, or a pharmacy technician a cost share charged to a covered individual that exceeds the total submitted charges by the pharmacy or pharmacist to the pharmacy benefit manager.

III.  A pharmacy benefit manager may only directly or indirectly charge or hold a pharmacy, a pharmacist, or a pharmacy technician responsible for a fee related to the adjudication of a claim if:

(a)  The total amount of the fee is identified, reported, and specifically explained for each line item on the remittance advice of the adjudicated claim; or

(b)  The total amount of the fee is apparent at the point of sale and not adjusted between the point of sale and the issuance of the remittance advice.

IV.  A pharmacy benefit manager, or any other third party, that reimburses a 340B entity for drugs that are subject to an agreement under 42 U.S.C. section 256b shall not reimburse the 340B entity for pharmacy-dispensed drugs at a rate lower than that paid for the same drug to pharmacies similar in prescription volume that are not 340B entities, and shall not assess any fee, charge-back, or other adjustment upon the 340B entity on the basis that the 340B entity participates in the program set forth in 42 U.S.C. section256b.

V.  With respect to a patient eligible to receive drugs subject to an agreement under 42 U.S.C. section 256b, a pharmacy benefit manager, or any other third party that makes payment for such drugs, shall not discriminate against a 340B entity in a manner that prevents or interferes with the patient's choice to receive such drugs from the 340B entity.  Provided, that for purposes of this section, "third party" does not include:

(a)  The state Medicaid program when Medicaid is providing reimbursement for covered outpatient drugs, as that term is defined in 42 U.S.C. section1396r-8(k), on a fee-for-service basis; or

(b)  A Medicaid-managed care organization as described in 42 U.S.C. section 1396b(m).

VI.  A pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee of $10.49; provided, that if the national average drug acquisition cost is not available at the time a drug is administered or dispensed, a pharmacy benefit manager may not reimburse in an amount that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. section 1395w-3a(c)(6)(B), plus a professional dispensing fee of $10.49.

VII.  A pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the amount the pharmacy benefit manager reimburses itself or an affiliate for the same prescription drug or pharmacy service.

VIII.  The commissioner may order reimbursement to an insured, pharmacy, or dispenser who has incurred a monetary loss as a result of a violation of this article or legislative rules implemented pursuant to this chapter.

IX.(a)  Any methodologies utilized by a pharmacy benefits manager in connection with reimbursement shall be filed with the commissioner at the time of initial licensure and at any time thereafter that the methodology is changed by the pharmacy benefit manager for use in determining maximum allowable cost appeals.  The methodologies are not subject to disclosure and shall be treated as confidential and exempt from disclosure under RSA 91-A.

(b)  A pharmacy benefits manager shall utilize the national average drug acquisition cost as a point of reference for the ingredient drug product component of a pharmacy's reimbursement for drugs appearing on the national average drug acquisition cost list.

X.  A pharmacy benefits manager may not:

(a)  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; or

(b)  Engage in any practice that:

(1)  In any way bases pharmacy reimbursement for a drug on patient outcomes, scores, or metrics.  This does not prohibit pharmacy reimbursement for pharmacy care, including dispensing fees from being based on patient outcomes, scores, or metrics so long as the patient outcomes, scores, or metrics are disclosed to and agreed to by the pharmacy in advance;

(2)  Includes imposing a point-of-sale fee or retroactive fee; or

(3)  Derives any revenue from a pharmacy or insured in connection with performing pharmacy benefits management services.  Provided, that this nothing in this section shall be construed to prohibit pharmacy benefits managers from receiving deductibles or copayments.

XI.  A pharmacy benefits manager shall offer a health plan the option of charging such health plan the same price for a prescription drug as it pays a pharmacy for the prescription drug.  Provided, that a pharmacy benefits manager shall charge a health benefit plan administered by or on behalf of the state or a political subdivision of the state, the same price for a prescription drug as it pays a pharmacy for the prescription drug.

XII.  A covered individual's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 100 percent of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.  Any rebate over and above the defined cost sharing would then be passed on to the health plan to reduce premiums.  Nothing precludes an insurer from decreasing a covered individual's defined cost sharing by an amount greater than what is previously stated.  The commissioner shall adopt administrative rules pursuant to RSA 541-A to effectuate the provisions of this section.

402-N:4  Freedom of Consumer Choice for Pharmacy.

I.  A pharmacy benefits manager or health benefit plan may not:

(a)  Prohibit or limit any covered individual from selecting a pharmacy or pharmacist of his or her choice who has agreed to participate in the plan according to the terms offered by the insurer;

(b)  Deny a pharmacy or pharmacist the right to participate as a contract provider under the policy or plan if the pharmacy or pharmacist agrees to provide pharmacy services, including, but not limited to, prescription drugs, that meet the terms and requirements set forth by the insurer under the policy or plan and agrees to the terms of reimbursement set forth by the insurer;

(c)  Impose upon a beneficiary of pharmacy services under a health benefit plan any copayment, fee, or condition that is not equally imposed upon all beneficiaries in the same benefit category, class, or copayment level under the health benefit plan when receiving services from a contract provider;

(d)  Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those pharmacies or pharmacists who have agreed to participate in the plan according to the terms offered by the insurer.  Monetary advantage or penalty includes higher copayment, a reduction in reimbursement for services, or promotion of one participating pharmacy over another by these methods;

(e)  Reduce allowable reimbursement for pharmacy services to a beneficiary under a health benefit plan because the beneficiary selects a pharmacy of his or her choice, so long as that pharmacy has enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area;

(f)  Require a beneficiary, as a condition of payment or reimbursement, to purchase pharmacy services, including prescription drugs, exclusively through a mail-order pharmacy; or

(g)  Impose upon a beneficiary any copayment, amount of reimbursement, number of days of a drug supply for which reimbursement will be allowed, or any other payment or condition relating to purchasing pharmacy services from any pharmacy, including prescription drugs, that is more costly or more restrictive than that which would be imposed upon the beneficiary if such services were purchased from a mail-order pharmacy or any other pharmacy that is willing to provide the same services or products for the same cost and copayment as any mail order service.

II.  If a health benefit plan providing reimbursement to New Hampshire residents for prescription drugs restricts pharmacy participation, the entity providing the health benefit plan shall notify, in writing, all pharmacies within the geographical coverage area of the health benefit plan, and offer to the pharmacies the opportunity to participate in the health benefit plan at least 60 days prior to the effective date of the plan.  All pharmacies in the geographical coverage area of the plan shall be eligible to participate under identical reimbursement terms for providing pharmacy services, including prescription drugs.  The entity providing the health benefit plan shall, through reasonable means, on a timely basis and on regular intervals, inform the beneficiaries of the plan of the names and locations of pharmacies that are participating in the plan as providers of pharmacy services and prescription drugs.  Additionally, participating pharmacies shall be entitled to announce their participation to their customers through a means acceptable to the pharmacy and the entity providing the health benefit plans.  The pharmacy notification provisions of this section shall not apply when an individual or group is enrolled, but when the plan enters a particular county of the state.

III.  The commissioner shall not approve any pharmacy benefits manager or health benefit plan providing pharmaceutical services which do not conform to this section.

IV.  Any covered individual or pharmacy injured by a violation of this section may maintain a cause of action to enjoin the continuance of any such violation.

V.  This section shall apply to all pharmacy benefits managers and health benefit plans providing pharmaceutical services benefits, including prescription drugs, to any resident of New Hampshire.  For purposes of this section, "health benefit plan" means any entity or program that provides reimbursement for pharmaceutical services.  This section shall also apply to insurance companies and health maintenance organizations that provide or administer coverages and benefits for prescription drugs.  This section shall not apply to any entity that has its own facility, employs or contracts with physicians, pharmacists, nurses and other health care personnel, and that dispenses prescription drugs from its own pharmacy to its employees and dependents enrolled in its health benefit plan; but this section shall apply to an entity otherwise excluded that contracts with an outside pharmacy or group of pharmacies to provide prescription drugs and services.

402-N:5  Reporting Requirements.

I.  A pharmacy benefits manager shall report to the commissioner on an annual basis, or more often as the commissioner deems necessary, for each health plan or covered entity the following information:

(a)  The aggregate amount of rebates received by the pharmacy benefits manager;

(b)  The aggregate amount of rebates distributed to each health plan or covered entity contracted with the pharmacy benefits manager;

(c)  The aggregate amount of rebates passed on to the enrollees of each health plan or covered entity at the point of sale that reduced the enrollees applicable deductible, copayment, coinsurance, or other cost-sharing amount;

(d)  The individual and aggregate amount paid by the health plan or covered entity to the pharmacy benefits manager for pharmacist services itemized by pharmacy, by product, and by goods and services; and

(e)  The individual and aggregate amount a pharmacy benefits manager paid for pharmacist services itemized by pharmacy, by product, and by goods and services.

II.  A pharmacy benefits manager shall annually report in the aggregate to the commissioner and to a health plan or covered entity the difference between the amount the pharmacy benefits manager reimbursed a pharmacy and the amount the pharmacy benefits manager charged a health plan.

III.  A health benefit plan or covered entity shall annually report to the commissioner the aggregate amount of credits, rebates, discounts, or other such payments received by the health benefit plan or covered entity from a pharmacy benefits manager or drug manufacturer and disclose whether or not those credits, rebates, discounts or other such payments were passed on to reduce insurance premiums or rates.  The commissioner shall consider the information in this report in reviewing any premium rates charged for any individual or group accident and health insurance policy.

IV.  A pharmacy benefits manager shall produce a quarterly report to the commissioner of all drugs appearing on the national average drug acquisition cost list reimbursed 10 percent and below the national average drug acquisition cost, as well as all drugs reimbursed 10 percent and above the national average drug acquisition cost.  For each drug in the report, a pharmacy benefits manager shall include the month the drug was dispensed, the quantity of the drug dispensed, the amount the pharmacy was reimbursed, whether the dispensing pharmacy was an affiliate of the pharmacy benefits manager, whether the drug was dispensed pursuant to a government health plan, and the average national drug acquisition cost for the month the drug was dispensed.  The report shall exclude drugs dispensed pursuant to 42 U.S.C. section 256b.  A copy of this report shall also be published on the pharmacy benefits manager's publicly available website for a period of at least 24 months.  This report is exempt from the confidentiality provisions of paragraph VI.

V.  The reports shall be filed electronically on a form and manner as prescribed by the commissioner pursuant to administrative rules adopted by the commissioner.

VI.  With the exception of the quarterly report noted in subsection (d) of this section all data and information provided by the pharmacy benefits manager, health plan, or covered entity pursuant to these established reporting requirements shall be considered proprietary and confidential and exempt from disclosure under the RSA 91-A.

2  Pharmacists and Pharmacies; Definitions.  Amend RSA 318:1, XI-a to read as follows:

XI-a.  "Pharmacy benefits manager" means "pharmacy benefits manager" as defined in RSA [402-N:1, VIII] 402-N:2, XXI.

3  Managed Care Law; Definitions.  Amend RSA 420-J:3, XXVIII-a to read as follows:

XXVIII-a.  "Pharmacy benefits manager" means "pharmacy benefits manager" as defined in RSA [402-N:1, VIII] 402-N:2, XXI.

4  Effective Date.  This act shall take effect 60 days after its passage.

 

LBA

22-2448

12/14/21

 

HB 1580-FN- FISCAL NOTE

AS INTRODUCED

 

AN ACT relative to pharmacy benefits managers.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2022

FY 2023

FY 2024

FY 2025

   Appropriation

$0

$0

$0

$0

   Revenue

$0

Indeterminable

Indeterminable

Indeterminable

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

Funding Source:

  [ X ] General            [    ] Education            [ X ] Highway           [ X ] Other - Insurance Premium Tax, License and Renewal Fees, various government funds

 

 

 

 

 

COUNTY:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

 

 

 

 

LOCAL:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

METHODOLOGY:

The Insurance Department states this bill creates a new Pharmacy Benefit Manager (PBM) chapter.  The new chapter differs from current law in a number of ways:

  • The bill would require licensure, where the current law requires registration.  Requirements for licensure include evidence of financial responsibility of at least $1,000,000 and demonstration of an adequate network.  
  • The bill places certain limitations on what a PBM may collect from a pharmacy or require a pharmacy to charge.  
  • The bill requires PBM to include in its network all pharmacies that are willing to agree to the PBMs terms and prohibits PBMs from imposing financial incentives to advantage some pharmacies over others.  
  • While the current law requires certain reporting, the bill requires more specific reporting and more frequent reporting.

 

The Insurance Department assumes it would be able to handle the additional responsibilities required of the Department with its existing resources.  To the extent the bill imposes additional administrative burdens on PBMs, this could translate into inflationary pressures on prescription drug claims.  Such inflationary claim pressure may result in increased premiums, benefit design changes and/or consumer buy-downs.  The impact on premium tax is indeterminable.  

 

AGENCIES CONTACTED:

Insurance Department

 

Links


Date Body Type
Feb. 2, 2022 House Hearing
Feb. 2, 2022 House Hearing
March 3, 2022 House Exec Session
House Floor Vote

Bill Text Revisions

HB1580 Revision: 34447 Date: Dec. 21, 2021, 10:34 a.m.

Docket


March 15, 2022: Inexpedient to Legislate: MA VV 03/15/2022


March 8, 2022: Committee Report: Inexpedient to Legislate (Vote 16-2; CC)


Feb. 28, 2022: Subcommittee Work Session: 03/03/2022 10:00 am LOB 302-304


March 3, 2022: Executive Session: 03/03/2022 1:15 p.m. LOB302-304


Feb. 3, 2022: Subcommittee Work Session: 02/10/2022 01:15 pm LOB 302-304


Feb. 2, 2022: Public Hearing: 02/02/2022 2:30 p.m. LOB302-304


Feb. 2, 2022: Public Hearing: 02/02/2022 2:30 p.m. LOB302-304


Dec. 21, 2021: Introduced 01/05/2022 and referred to Commerce and Consumer Affairs