FREEDOM OF CHOICE FOR PHARMACY SERVICES (Sections 338.015)

The act specifies that certain provisions of law pertaining to pharmacists and pharmacies shall not be construed to prohibit patients' ability to obtain prescription services from any licensed pharmacist "or pharmacy", and repeals language specifying that the provisions do not remove patients' ability to waive their freedom of choice under a contract with regard to payment or coverage of prescription expenses. (Section 338.015.1). Under the act, no pharmacy benefits manager shall penalize or restrict a covered person from obtaining services from a contracted pharmacy, as such terms are defined by law. (Section 338.015.4).

These provisions are identical to provisions in SB 402 (2023), provisions in HB 197 (2023), and substantially similar to provisions in SB 921 (2022), provisions in HCS/HB 1677 (2022), provisions in SB 971 (2020), provisions in HCS/HB 2412 (2020), provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), provisions in HB 1910 (2020), provisions in SB 413 (2019), and provisions in HB 1165 (2019).

PHARMACY BENEFITS MANAGERS (Section 376.387 and 376.388)

Additionally, the act modifies the applicable definition of "covered person" for purposes of certain statutes governing pharmacy benefits managers (PBMs) to apply only to individuals who receive prescription drug coverage through a PBM (Section 376.387.1(1)), specifies that a pharmacy or pharmacist may provide to a plan sponsor any information related to the sponsor's plan that does not disclose information about a specific covered person's prescription use (Section 376.387.3(2)), repeals a provision of law allowing PBMs to hold pharmacists or pharmacies responsible for fees related to charges for administering a health benefit plan (Section 376.387.4), and repeals a provision of law specifying that certain PBM regulations shall not apply with regard to Medicare Part D or other health plans regulated under federal law. (Former section 376.387.5). The act provides standardized definitions for the terms "generic" and "rebate" applicable to PBMs and health carriers (Section 376.387.6-7), and specifies that PBMs shall owe a fiduciary duty to the entities with which it contracts. (Section 376.387.8). No entity contracting with pharmacies to sell, provide, pay, or reimburse pharmacies for prescription drugs shall prohibit a plan sponsor or a participating pharmacy from discussing any health benefit plan information or costs. (Section 376.387.9). PBMs shall not charge a health benefit plan or payer different amounts for drugs' ingredient costs or dispensing fees than it reimburses the pharmacy if the PBM retains the difference. (Section 376.387.10).

The act repeals a portion of a definition to specify that certain provisions relating to the maximum allowable cost of a prescription drug are applicable to all pharmacies, rather than only to contracted pharmacies (Section 376.388.1(1)), and modifies the applicable definition of PBM to refer to any entity that administers or manages a pharmacy benefits plan or program, as defined in the act. (Section 376.388.1(5)). If the reimbursement for a drug to a contracted pharmacy is below the pharmacy's cost to purchase the drug, the pharmacy may decline to dispense the prescription. (Section 376.388.5(2)). No PBM shall reimburse a pharmacist or pharmacy in the state an amount less than the amount that the PBM reimburses a PBM affiliate, as defined in the act, for providing the same pharmacist services. (Section 376.388.5(3)).

These provisions are similar to provisions in SB 402 (2023), provisions in HB 197 (2023), provisions in SB 921 (2022), provisions in HCS/HB 1677 (2022), provisions in SB 971 (2020), provisions in HCS/HB 2412 (2020), provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), provisions in HB 1910 (2020), provisions in SB 413 (2019), and provisions in HB 1165 (2019).

ERIC VANDER WEERD