SB2738 - State employees health plan; set provisions and restrictions related to pharmacy benefit manager.

2 Co-Sponsors

An Act To Amend Section 25-15-301, Mississippi Code Of 1972, To Make Certain Revisions Related To The State And School Employees Health Insurance Management Board; To Provide That When A Proposal Is Under The Board's Evaluation For Pharmacy Benefits Or The Management Thereof, The Executive Director Of The Mississippi Board Of Pharmacy Shall Be One Of The Members Of The Evaluation Committee Of The Board; To Amend Section 25-15-303, Mississippi Code Of 1972, To Include The Executive Director Of The Board Of Pharmacy As A Member Of The Management Board; To Create New Section 25-15-305, Mississippi Code Of 1972, To Set Certain Definitions Related To The Act, Including The Definitions Of Clean Claims, Pharmacy Benefit Plan, Pharmacy Benefit Management Plan ("pbm") And Rebate; To Provide That The Act Shall Only Apply To The Pbm And Its Affiliate That Administer The State Health Plan; To Create New Section 25-15-307, Mississippi Code Of 1972, To Provide That A Pbm Shall Not Reimburse A Pharmacy Or Pharmacist For A Prescription Drug Or Pharmacist Service In A Net Amount Less Than The National Average Drug Acquisition Cost For The Prescription Drug Or Pharmacist Service In Effect At The Time That The Drug Or Service Is Administered Or Dispensed, Plus A Professional Dispensing Fee At Least Equal To The Professional Dispensing Fee Paid By The Mississippi Division Of Medicaid For Outpatient Drugs; To Prohibit Pbms From Charging A Plan Sponsor More For A Prescription Drug Than The Net Amount It Pays A Pharmacy For The Prescription Drug; To Require Pbms To Pay Clean Claims Within A Certain Time Constraint; To Provide Certain Exceptions From This Time Constraint; To Provide That If The Board Finds That Any Pbm, Agent Or Other Party Responsible For Reimbursement For Prescription Drugs And Other Products Has Not Paid Ninety-five Percent Of Clean Claims Received From All Pharmacies In A Calendar Quarter, He Shall Be Subject To Administrative Penalty Of Not More Than $25,000.00 To Be Assessed By The Board; To Authorize The Board To Adopt Rules And Regulations Necessary To Ensure Compliance With This Act; To Authorize A Network Pharmacy Or Pharmacist To Decline To Provide A Brand Name Drug, Multisource Generic Drug, Or Service, If The Network Pharmacy Or Pharmacist Is Paid Less Than That Network Pharmacy's Cost For The Prescription; To Create New Section 25-15-309, Mississippi Code Of 1972, To Set Certain Requirements Related To Pbm, Including That The Pbm Must Provide A Reasonable Administrative Appeal Procedure; To Authorize The Board To Audit Pbms; To Require A Pbm To Reimburse A Pharmacy Or Pharmacist An Amount Less Than The Amount That The Pbm Reimburses A Pbm Affiliate For Providing The Same Pharmacist Services; To Create New Section 25-15-311, Mississippi Code Of 1972, To Require Pbms To Obtain A License From The Board Of Pharmacy; To Create New Section 25-15-313, Mississippi Code Of 1972, To Require Pbms To Pass On To The Plan 100% Of All Rebates And Other Payments That It Receives Directly Or Indirectly From Pharmaceutical Manufacturers In Connection With Claims Or Plan Administration On Behalf Of The Plan; To Prohibit A Pbm Or Third-party Payer From Charging Or Causing A Patient To Pay A Copayment That Exceeds The Total Reimbursement Paid By The Pbm To The Pharmacy; To Create New Section 25-15-315, Mississippi Code Of 1972, To Prohibit A Pharmacy, Pbm, Or Pbm Affiliate From Taking Certain Actions, Including Making Referrals Or Interfering With A Patient's Right To Choose Their Pharmacy; To Create New Section 25-15-317, Mississippi Code Of 1972, To Prohibit Pbms From Retaliating Against A Pharmacist Or Pharmacy Based On The Pharmacist's Or Pharmacy's Exercise Of Any Right Or Remedy Under This Act; To Create New Section 25-15-319, Mississippi Code Of 1972, To Authorize The Board To Bring An Action Against A Pbm Or Pbm Affiliate To Restrain By Temporary Or Permanent Injunction The Use Of Any Method That Is Prohibited By This Act; To Authorize The Board To Impose A Monetary Penalty On Any Pbm Found To Be In Noncompliance; To Create New Section 25-15-319, Mississippi Code Of 1972, To Provide That On The Request By Any Agency Of The State Of Mississippi, Or Any Political Subdivision Of The State Or Any Other Public Entity, A Pbm Shall Deliver Or Otherwise Make Available To The Requesting Agency Or Entity, In Its Entirety And With No Redaction, Any Third-party Aggregator Contracts Or Contracts Relating To Pbm Services; To Provide That Any Entity That Does Not Comply With This Section Shall Be Barred For Five Years From Doing Business In The State; And For Related Purposes.