Bill Text: MS HB1111 | 2016 | Regular Session | Introduced
Bill Title: Pharmacy benefit managers; require fair payment for pharmacy service by.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2016-02-23 - Died In Committee [HB1111 Detail]
Download: Mississippi-2016-HB1111-Introduced.html
MISSISSIPPI LEGISLATURE
2016 Regular Session
To: Public Health and Human Services; Insurance
By: Representative Mims
House Bill 1111
AN ACT TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO INCLUDE NEW DEFINITIONS IN THE PHARMACY PROMPT PAY ACT; TO CREATE NEW SECTIONS 73-21-161, 73-21-163 AND 73-21-165, MISSISSIPPI CODE OF 1972, TO ADD NEW PROVISIONS TO THE PHARMACY PROMPT PAY ACT TO PROHIBIT A PHARMACY BENEFIT MANAGER FROM REIMBURSING A NETWORK PHARMACY OR PHARMACIST IN THE STATE AN AMOUNT LESS THAN THE AMOUNT THAT THE PHARMACY BENEFIT MANAGER REIMBURSES A PHARMACY OWNED OR OPERATED BY THE PHARMACY BENEFIT MANAGER, A PHARMACY BENEFIT MANAGER, OR A PHARMACY BENEFIT MANAGER AFFILIATE, FOR DISPENSING MULTI-SOURCE GENERIC DRUG PRESCRIPTIONS; TO PROVIDE THAT A NETWORK PHARMACY OR PHARMACIST MAY DECLINE TO PROVIDE A MULTI-SOURCE GENERIC DRUG, OR SERVICE, IF THE NETWORK PHARMACY OR PHARMACIST IS PAID LESS THAN THAT NETWORK PHARMACY'S ACQUISITION COST FOR THE PRODUCT; TO PROVIDE THAT A NETWORK PHARMACY OR ITS CONTRACTING REPRESENTATIVE SHALL BE PROVIDED WITH A MINIMUM OF SIXTY DAYS TO RESPOND TO ANY NEW PHARMACY BENEFIT MANAGER CONTRACT, CONTRACT RENEWAL, AMENDMENT OR ADDENDUM TO AN EXISTING CONTRACT; TO PROVIDE THAT THE STATE BOARD OF PHARMACY SHALL HAVE ENFORCEMENT AUTHORITY OVER THE PROVISIONS OF THOSE NEW SECTIONS, AND AUTHORIZE THE BOARD TO IMPOSE A MONETARY PENALTY ON PHARMACY BENEFIT MANAGERS FOR NONCOMPLIANCE WITH THE PROVISIONS OF THOSE SECTIONS; TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PRECEDING PROVISIONS; TO AMEND SECTION 73-21-159, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PRECEDING PROVISIONS AND TO DELETE THE REPEALER ON THE SECTION; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 73-21-153, Mississippi Code of 1972, is amended as follows:
73-21-153. For purposes of
Sections 73-21-151 through 73-21- * * *165, the following words and phrases
shall have the meanings ascribed * * * in this section unless the
context clearly indicates otherwise:
(a) "Board" means the State Board of Pharmacy.
(b) "Commissioner" means the Mississippi Commissioner of Insurance.
(c) "Contracting representative" means any entity that provides contracting or other administrative services to pharmacies to assist pharmacies in the interaction with third-party payers, pharmacy benefit managers or wholesalers or providers of other necessary contracting or purchasing relationships, including, but not limited to, pharmacy services administrative organizations.
( * * *d) "Day" means a calendar
day, unless otherwise defined or limited.
( * * *e) "Electronic claim" means
the transmission of data for purposes of payment of covered prescription drugs,
other products and supplies, and pharmacist services in an electronic data
format specified by a pharmacy benefit manager and approved by the department.
( * * *f) "Electronic adjudication"
means the process of electronically receiving, reviewing and accepting or
rejecting an electronic claim.
( * * *g) "Enrollee" means an
individual who has been enrolled in a pharmacy benefit management plan.
( * * *h) "Health insurance plan"
means benefits consisting of prescription drugs, other products and supplies,
and pharmacist services provided directly, through insurance or reimbursement,
or otherwise and including items and services paid for as prescription drugs,
other products and supplies, and pharmacist services under any hospital or
medical service policy or certificate, hospital or medical service plan
contract, preferred provider organization agreement, or health maintenance
organization contract offered by a health insurance issuer, unless preempted as
an employee benefit plan under the Employee Retirement Income Security Act of
1974. However, "health insurance coverage" shall not include
benefits due under the workers compensation laws of this or any other state.
(i) “Multi-source generic drug” means a covered outpatient prescription drug for which there is at least one (1) other drug product that is rated as therapeutically equivalent under the Food and Drug Administration's most recent publication of "Approved Drug Products with Therapeutic Equivalence Evaluations;" is pharmaceutically equivalent and bioequivalent, as determined by the Food and Drug Administration; and is sold or marketed in the state during the period.
(j) "Network pharmacy" means a licensed pharmacy in the state that has a contract with a pharmacy benefits manager, or health plan sponsor that serves beneficiaries in the state, either directly or through a contracting representative, to provide covered drugs at a negotiated reimbursement rate.
( * * *k) "Pharmacy benefit
manager" shall have the same definition as provided in Section 73-21-179.
However, * * * the term "pharmacy benefit manager"
shall not include an insurance company unless the insurance company is
providing services as a pharmacy benefit manager as defined in Section 73-21-179,
in which case the insurance company shall be subject to Sections 73-21-151
through 73-21- * * *165
only for those pharmacy benefit manager services. In addition, the term
"pharmacy benefit manager" shall not include the pharmacy benefit
manager of the Mississippi State and School Employees Health Insurance Plan or
the Mississippi Division of Medicaid or its contractors when performing
pharmacy benefit manager services for the Division of Medicaid.
(l) "Pharmacy benefit manager affiliate" means any person or entity that directly or indirectly, through one (1) or more intermediaries owns or controls, is owned or controlled by, or is under common ownership or control with a pharmacy benefit manager.
( * * *m) "Pharmacy benefit management
plan" shall have the same definition as provided in Section 73-21-179.
( * * *n) "Pharmacist,"
"pharmacist services" and "pharmacy" or
"pharmacies" shall have the same definitions as provided in Section
73-21-73.
( * * *o) "Uniform claim form"
means a form prescribed by rule by the State Board of Pharmacy; however,
for purposes of Sections 73-21-151 through 73-21- * * *165, the board shall adopt the same
definition or rule where the State Department of Insurance has adopted a rule
covering the same type of claim. The board may modify the terminology of the
rule and form when necessary to comply with the provisions of Sections 73-21-151
through 73-21- * * *165.
( * * *p) "Plan sponsors" means the
employers, insurance companies, unions and health maintenance organizations
that contract with a pharmacy benefit manager for delivery of prescription
services.
SECTION 2. The following shall be codified as Section 73-21-161, Mississippi Code of 1972:
73-21-161. (1) A pharmacy benefit manager shall not reimburse a network pharmacy or pharmacist in the state an amount less than the amount that the pharmacy benefit manager reimburses a pharmacy owned or operated by the pharmacy benefit manager, a pharmacy benefit manager, or a pharmacy benefit manager affiliate, for dispensing multi-source generic drug prescriptions.
(2) A network pharmacy or pharmacist may decline to provide a multi-source generic drug, or service, if the network pharmacy or pharmacist is paid less than that network pharmacy's acquisition cost for the product.
SECTION 3. The following shall be codified as Section 73-21-163, Mississippi Code of 1972:
73-21-163. A network pharmacy or its contracting representative shall be provided with a minimum of sixty (60) days to respond to any new pharmacy benefit manager contract, contract renewal, amendment or addendum to an existing contract.
SECTION 4. The following shall be codified as Section 73-21-165, Mississippi Code of 1972:
73-21-165. (1) The State Board of Pharmacy shall have enforcement authority over the provisions of Sections 73-21-161 and 73-21-163.
(2) Any violation of Section 73-21-161 or 73-21-163 may subject the pharmacy benefit manager to additional enforcement actions and penalties under the authority of the board. The board may impose a monetary penalty on pharmacy benefit managers for noncompliance with the provisions of Section 73-21-161 or 73-21-163 in amounts of not less than One Thousand Dollars ($1,000.00) per violation and not more than Twenty-five Thousand Dollars ($25,000.00) per violation. The board shall prepare a record entered upon its minutes that states the basic facts upon which the monetary penalty was imposed. Any penalty collected under this subsection (2) shall be deposited into the special fund of the board created under Section 73-21-113.
(3) The board may assess a monetary penalty for those reasonable costs that are expended by the board in the investigation and conduct of a proceeding if the board imposes a monetary penalty under subsection (2) of this section. Money collected by the board under this subsection (3) shall be deposited to the credit of the special fund of the board created under Section 73-21-113.
(4) A pharmacy benefit manager shall not terminate from a network or contract, or retaliate against a network pharmacy or its contracting entity for exercising its rights under federal, state, or local laws, regulations or rules including, but not limited to availing itself of its rights under Sections 73-21-161 and 73-21-163. Any violation of this subsection shall be subject to the enforcement provisions in subsection (2) of this section.
SECTION 5. Section 73-21-151, Mississippi Code of 1972, is amended as follows:
73-21-151. Sections 73-21-151
through 73-21- * * *165
shall be known as the "Pharmacy Benefit Prompt Pay Act."
SECTION 6. Section 73-21-159, Mississippi Code of 1972, is amended as follows:
73-21-159. (1) In lieu of or in addition to making its own financial examination of a pharmacy benefit manager, the board may accept the report of a financial examination of other persons responsible for the pharmacy benefit manager under the laws of another state certified by the applicable official of such other state.
(2) The board shall
coordinate financial examinations of a pharmacy benefit manager that provides
pharmacy management benefit plans in this state to ensure an appropriate level
of regulatory oversight and to avoid any undue duplication of effort or
regulation. The pharmacy benefit manager being examined shall pay the cost of
the examination. The cost of the examination shall be deposited in a special
fund that shall provide all expenses for the licensing, supervision and
examination of all pharmacy benefit managers subject to regulation under
Sections 73-21-71 through 73-21-129 and Sections 73-21-151 through 73-21- * * *165.
(3) The board may provide a copy of the financial examination to the person or entity who provides or operates the health insurance plan or to a pharmacist or pharmacy.
(4) The board is authorized to hire independent financial consultants to conduct financial examinations of a pharmacy benefit manager and to expend funds collected under this section to pay the costs of such examinations.
* * *
SECTION 7. This act shall take effect and be in force from and after July 1, 2016.
