2015 -- H 5602 SUBSTITUTE A AS AMENDED

========

LC001431/SUB A/4

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

____________

A N   A C T

RELATING TO INSURANCE - PRESCRIPTION DRUG BENEFITS

     

     Introduced By: Representatives Kennedy, Azzinaro, Keable, Winfield, and Shekarchi

     Date Introduced: February 25, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

2

Insurance Policies" is hereby amended by adding thereto the following section:

3

     27-18-33.2. Pharmacy benefit manager requirements with respect to multi-source

4

generic pricing updates to pharmacies. – (a) Definitions. As used herein:

5

     (1) "Maximum allowable cost" means the maximum amount that a pharmacy benefits

6

manager will pay toward the cost of a drug;

7

     (2) "Nationally available" means that all pharmacies in this state can purchase the drug

8

from regional or national wholesalers and that the product is not obsolete or temporarily

9

unavailable;

10

     (3) "Therapeutically equivalent" means the equivalent determined by the United States

11

Food and Drug Administration.

12

     (b) "Pharmacy benefit manager" (PBM) means and refers to all requirements with respect

13

to multi-source generic pricing updates to pharmacies:

14

     (1) Upon each contract execution or renewal, a PBM shall, with respect to contracts

15

between PBM and a pharmacy or, alternatively, a PBM and a pharmacy's contracting

16

representative or agent such as a pharmacy services administrative organization (PSAO):

17

     (i) Include in such contracts a requirement that the PBM update such maximum allowable

18

costs (MAC) pricing information on such contracts at least every ten (10) calendar days, and

19

establish a reasonable process for the prompt notification of such pricing updates to network

 

1

pharmacies.

2

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

3

Corporations" is hereby amended by adding thereto the following section:

4

     27-19-42.1. Pharmacy benefit manager requirements with respect to multi-source

5

generic pricing updates to pharmacies. -- (a) Definitions. As used herein:

6

     (1) "Maximum allowable cost" means the maximum amount that a pharmacy benefits

7

manager will pay toward the cost of a drug;

8

     (2) "Nationally available" means that all pharmacies in this state can purchase the drug

9

from regional or national wholesalers and that the product is not obsolete or temporarily

10

unavailable;

11

     (3) "Therapeutically equivalent" means the equivalent determined by the United States

12

Food and Drug Administration.

13

     (b) "Pharmacy benefit manager" (PBM) means and refers to all requirements with respect

14

to multi-source generic pricing updates to pharmacies:

15

     (1) Upon each contract execution or renewal, a PBM shall, with respect to contracts

16

between PBM and a pharmacy or, alternatively, a PBM and a pharmacy's contracting

17

representative or agent such as a pharmacy services administrative organization (PSAO):

18

     (i) Include in such contracts a requirement that the PBM update such maximum allowable

19

costs (MAC) pricing information on such contracts at least every ten (10) calendar days, and

20

establish a reasonable process for the prompt notification of such pricing updates to network

21

pharmacies.

22

     SECTION 3. Chapter 27-19.2 of the General Laws entitled "Nonprofit Hospital and

23

Medical Service Corporations" is hereby amended by adding thereto the following section:

24

     27-19.2-12. Pharmacy benefit manager requirements with respect to multi-source

25

generic pricing updates to pharmacies. -- (a) Definitions. As used herein:

26

     (1) "Maximum allowable cost" means the maximum amount that a pharmacy benefits

27

manager will pay toward the cost of a drug;

28

     (2) "Nationally available" means that all pharmacies in this state can purchase the drug

29

from regional or national wholesalers and that the product is not obsolete or temporarily

30

unavailable;

31

     (3) "Therapeutically equivalent" means the equivalent determined by the United States

32

Food and Drug Administration.

33

     (b) "Pharmacy benefit manager" (PBM) means and refers to all requirements with respect

34

to multi-source generic pricing updates to pharmacies:

 

LC001431/SUB A/4 - Page 2 of 5

1

     (1) Upon each contract execution or renewal, a PBM shall, with respect to contracts

2

between PBM and a pharmacy or, alternatively, a PBM and a pharmacy's contracting

3

representative or agent such as a pharmacy services administrative organization (PSAO):

4

     (i) Include in such contracts a requirement that the PBM update such maximum allowable

5

costs (MAC) pricing information on such contracts at least every ten (10) calendar days, and

6

establish a reasonable process for the prompt notification of such pricing updates to network

7

pharmacies.

8

     SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

9

Corporations" is hereby amended by adding thereto the following section:

10

     27-20.1-15.1. Pharmacy benefit manager requirements with respect to multi-source

11

generic pricing updates to pharmacies. -- (a) Definitions. As used herein:

12

     (1) "Maximum allowable cost" means the maximum amount that a pharmacy benefits

13

manager will pay toward the cost of a drug;

14

     (2) "Nationally available" means that all pharmacies in this state can purchase the drug

15

from regional or national wholesalers and that the product is not obsolete or temporarily

16

unavailable;

17

     (3) "Therapeutically equivalent" means the equivalent determined by the United States

18

Food and Drug Administration.

19

     (b) "Pharmacy benefit manager" (PBM) means and refers to all requirements with respect

20

to multi-source generic pricing updates to pharmacies:

21

     (1) Upon each contract execution or renewal, a PBM shall, with respect to contracts

22

between PBM and a pharmacy or, alternatively, a PBM and a pharmacy's contracting

23

representative or agent such as a pharmacy services administrative organization (PSAO):

24

     (i) Include in such contracts a requirement that the PBM update such maximum allowable

25

costs (MAC) pricing information on such contracts at least every ten (10) calendar days, and

26

establish a reasonable process for the prompt notification of such pricing updates to network

27

pharmacies.

28

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

29

Organizations" is hereby amended by adding thereto the following section:

30

     27-41-38.1. Pharmacy benefit manager requirements with respect to multi-source

31

generic pricing updates to pharmacies. -- (a) Definitions. As used herein:

32

     (1) "Maximum allowable cost" means the maximum amount that a pharmacy benefits

33

manager will pay toward the cost of a drug;

34

     (2) "Nationally available" means that all pharmacies in this state can purchase the drug

 

LC001431/SUB A/4 - Page 3 of 5

1

from regional or national wholesalers and that the product is not obsolete or temporarily

2

unavailable;

3

     (3) "Therapeutically equivalent" means the equivalent determined by the United States

4

Food and Drug Administration.

5

     (b) "Pharmacy benefit manager" (PBM) means and refers to all requirements with respect

6

to multi-source generic pricing updates to pharmacies:

7

     (1) Upon each contract execution or renewal, a PBM shall, with respect to contracts

8

between PBM and a pharmacy or, alternatively, a PBM and a pharmacy's contracting

9

representative or agent such as a pharmacy services administrative organization (PSAO):

10

     (i) Include in such contracts a requirement that the PBM update such maximum allowable

11

costs (MAC) pricing information on such contracts at least every ten (10) calendar days, and

12

establish a reasonable process for the prompt notification of such pricing updates to network

13

pharmacies.

14

     SECTION 6. This act shall take effect on September 30, 2015.

========

LC001431/SUB A/4

========

 

LC001431/SUB A/4 - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - PRESCRIPTION DRUG BENEFITS

***

1

     This act would require that pharmacy benefit managers (PBM) include in each contract a

2

requirement that the PBM would update maximum allowable cost (MAC) pricing information

3

every ten (10) calendar days pertaining to policies relating to accident and sickness, nonprofit

4

hospital service corporations, nonprofit medical service corporations, nonprofit dental service

5

corporations and health maintenance organizations.

6

     This act would take effect on September 30, 2015.

========

LC001431/SUB A/4

========

 

LC001431/SUB A/4 - Page 5 of 5