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2004 SESSION

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HB 1455 Health insurance; allows for pharmacy of choice.

Introduced by: Clifford L. Athey, Jr. | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Health insurance; pharmacies; freedom of choice. Prohibits insurers from imposing upon pharmacies nonprice terms or conditions that are not equally required of all pharmacies in the Commonwealth, whether or not such benefits are furnished by pharmacists who are nonpreferred providers. The bill also prohibits insurers from requiring any payment, compensation, or reimbursement structure that results in, or would tend to result in: (i) discrimination in price or services to be rendered; (ii) the artificial depression of prices to be paid, or proposed to be paid, to a pharmacy providing pharmaceutical benefits; (iii) the establishment or unilateral change of reimbursement rates to a pharmacy that are below such pharmacy's costs or prevailing market rates; or (iv) direct or indirect discrimination by the insurer, where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly, or to injure, destroy, or prevent competition in the practice of pharmacy. Insurers are also prohibited from directly or indirectly paying or accepting rebates, discounts, or other forms of disclosed or undisclosed incentives between or among the insurer, the insurer's pharmacy benefit manager, or a pharmacy in a manner that would be a violation of state or federal law. Requiring or inducing a person receiving pharmacy benefits to use a mail order pharmacy for maintenance medications is also prohibited unless the pharmacy selected by such person has not agreed to accept reimbursement for such services at the same rates, terms, and conditions that are applicable to mail order pharmacies that have one or more contracts with the insurer.


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