Bill Text: HI SB667 | 2014 | Regular Session | Amended
Bill Title: Pharmacy Benefit Management Companies
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2013-12-18 - Carried over to 2014 Regular Session. [SB667 Detail]
Download: Hawaii-2014-SB667-Amended.html
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THE SENATE |
S.B. NO. |
667 |
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TWENTY-SEVENTH LEGISLATURE, 2013 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that pharmacy benefit management companies provide prescription drug services on behalf of plan sponsors, including self-insured employers, insurers, unions, mutual benefit societies, and health maintenance organizations. As part of these services, pharmacy benefit management companies are the intermediaries that negotiate services and costs with pharmacies and rebate earnings with pharmaceutical companies. Through this Act, the legislature seeks to ensure financial reliability and mandate disclosure of drug costs and financial contracts.
The purpose of this Act is to provide greater transparency regarding prescription drug coverage by requiring pharmacy benefit management companies to report to group health plans and provide information to pharmacies regarding their prescription drug services.
SECTION 2. The Hawaii Revised Statutes, is amended by adding a new chapter to be appropriately designated and to read as follows:
"CHAPTER
PHARMACY BENEFIT MANAGEMENT COMPANIES
§ ‑1 Definitions. As used in this chapter:
"Auditing entity" means a managed care company, insurance company, third-party payor or the representative of the managed care company, insurance company, or third-party payor.
"Commissioner" means the insurance commissioner.
"Enrollee" means an individual who is enrolled in a pharmacy benefit management plan.
"Pharmacist" has the same meaning as "registered pharmacist" as set forth in section 461-1.
"Pharmacist services" includes drug therapy and other patient care services provided by a pharmacist or pharmacy registered under chapter 461 intended to achieve outcomes that relate to the cure or prevention of a disease, elimination or reduction of a patient's symptoms, or arresting or slowing of a disease process as defined in the regulations of the board of pharmacy.
"Pharmacy" has the same meaning as set forth in section 461-1.
"Pharmacy benefit management company" means a business that administers the prescription drug or device portion of health insurance plans on behalf of plan sponsors, including self-insured employers, insurers, unions, mutual benefit societies, and health maintenance organizations.
"Pharmacy benefit management plan" means an arrangement for the delivery of pharmacist services in which a pharmacy benefit management company undertakes to provide, arrange for, pay for, or reimburse any of the costs of pharmacist services for an enrollee on a prepaid or insured basis.
"Pharmacy benefit manager" means a person or entity that performs pharmacy benefit management services for a pharmacy benefit management company and includes a person or entity in a contractual or employment relationship with a person or entity performing pharmacy benefit management services for a health plan.
§ ‑2 Reporting. (a) Notwithstanding any other provision of law to the contrary, a pharmacy benefit management company contracting with an auditing entity to provide prescription drug coverage in the State of Hawaii shall provide at least annually a report to each group health plan, including an accident and health or sickness insurance company under chapter 431, article 10A; a health maintenance organization under chapter 432D; a mutual benefit society or a nonprofit hospital and health service corporation under chapter 432; or any other entity providing a plan of health insurance, health benefits, or health services with which the pharmacy benefit management company has a contract.
(b) With respect to the contract described under subsection (a), the report under subsection (a) shall include:
(1) Information on the number and total amount paid to pharmacies for prescriptions filled under the contract, reported by the following types of pharmacies: mail order pharmacies, specialty pharmacies, and retail pharmacies;
(2) The total amount that the pharmacy benefit manager was paid by the plan or issuer for prescriptions filled under the contract, reported by the following types of pharmacies: mail order pharmacies, specialty pharmacies, and retail pharmacies;
(3) The total payment under the contract received from pharmaceutical manufacturers, including all rebates; market share rebates; disease management fees; data selling fees; sales target fees; discounts, including prompt payment discounts; price concessions; or administrative and other payments from pharmaceutical manufacturers;
(4) The total amount that the plan or issuer was paid by the pharmacy benefit manager for rebates received from pharmaceutical manufacturers under the contract; and
(5) Information on the overall percentage of generic drugs dispensed under the contract, separately at retail and mail order pharmacies, and the percentage of cases in which a generic drug was dispensed when available.
§ ‑3 Information for pharmacies. A pharmacy benefit management company shall provide to pharmacies that contract with the pharmacy benefit management company:
(1) The methodology that the pharmacy benefit management company uses to determine reimbursement;
(2) The frequency with which the pharmacy benefit management company provides updates to pharmacy product reimbursement benchmarks used to calculate prescription reimbursement to pharmacies; and
(3) Prompt payment to pharmacies for clean claims as required by state law.
§ ‑4 Rules. (a) The commissioner, in consultation with the board of pharmacy, shall adopt rules pursuant to chapter 91 for the purposes of implementing this chapter.
(b) No later than twenty days prior to the convening of each legislative session, the commissioner shall provide an annual aggregated report on pharmacy benefit management companies operating in the State. The commissioner shall establish rules to ensure that confidential and proprietary information is protected."
SECTION 3. This Act shall take effect on January 1, 2050.
Report Title:
Pharmacy Benefit Management Companies
Description:
Requires a pharmacy benefit management company contracting with an auditing entity to submit a report annually to each group health plan consisting of specified types of information relating to providing prescription drug coverage. Requires a pharmacy benefit management company to provide pharmacies information regarding reimbursement methodology, calculation, and payment. Requires the insurance commissioner, in consultation with the board of pharmacy, to adopt rules. Effective 01/01/50. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
