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2018 SESSION

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HB 1177 Health insurance; contracts with pharmacies and pharmacists, etc.

Introduced by: Todd E. Pillion | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED HOUSE:

Pharmacists and pharmacy practices. Provides that no provider contract between a health carrier or its pharmacy benefits manager and a pharmacy or its contracting agent shall contain a provision (i) authorizing the carrier or its pharmacy benefits manager to charge, (ii) requiring the pharmacy or pharmacist to collect, or (iii) requiring an enrollee to make, a copayment for a covered prescription drug in an amount that exceeds the least of the applicable copayment for the prescription drug that would be payable in the absence of this section or the cash price the enrollee would pay for the prescription drug if the enrollee purchased the prescription drug without using the enrollee's health plan. The measure requires provider contracts between a health carrier or its pharmacy benefits manager and a pharmacy or its contracting agent to contain specific provisions that allow a pharmacy to (a) disclose to an enrollee information relating to the provisions of this section and the availability of a more affordable therapeutically equivalent prescription drug; (b) sell a more affordable therapeutically equivalent prescription drug to an enrollee if one is available; and (c) offer and provide direct and limited delivery services to an enrollee as an ancillary service of the pharmacy. The measure applies to provider contracts entered into, amended, extended, or renewed on or after January 1, 2019. This bill is identical to SB 933.

SUMMARY AS INTRODUCED:

Pharmacists and pharmacy practices. Prohibits a pharmacy benefits manager from (i) prohibiting a pharmacist or pharmacy from providing an enrollee individual information on the amount of the enrollee's cost share for the enrollee's prescription drug and the clinical efficacy of a more affordable alternative drug if one is available; (ii) prohibiting a pharmacist or pharmacy from offering and providing store direct delivery services to an enrollee as an ancillary service of the pharmacy; (iii) charging or collecting from an enrollee a cost sharing payment that exceeds the total submitted charges by the pharmacy for which the pharmacy is paid; (iv) charging or holding a pharmacist or pharmacy responsible for a fee relating to the adjudication of a claim; (v) recouping funds from a pharmacy in connection with claims for which the pharmacy has already been paid without first complying with applicable law; and (vi) penalizing or retaliating against a pharmacist or pharmacy for exercising its rights. The measure prohibits provider contracts from including provisions that bar pharmacists from discussing lower-cost alternative drugs with consumers and selling lower-cost alternative drugs to consumers or using contract terms to prevent pharmacies from providing store direct delivery services. The measure applies to any provider contract entered into, renewed, or amended on or after October 1, 2018.