PRIOR PRINTER'S NO. 309 PRINTER'S NO. 2742
No. 282 Session of 1993
INTRODUCED BY OLASZ, DeWEESE, CESSAR, WOGAN, MICOZZIE,
CALTAGIRONE, COY, PETRARCA, ITKIN, GRUPPO, TRELLO, LEH,
MELIO, LUCYK, D. W. SNYDER, MERRY, STABACK, GAMBLE, GODSHALL,
JAROLIN, ROEBUCK, DALEY, D. R. WRIGHT, FAJT, BUXTON, PRESTON,
FREEMAN, HASAY, O'BRIEN, J. TAYLOR, BUNT, REINARD, MIHALICH,
HALUSKA, BELARDI, FARMER, TOMLINSON, VAN HORNE, ADOLPH,
DeLUCA, McCALL, COLAIZZO, YANDRISEVITS, KASUNIC, MARSICO,
LaGROTTA, BOYES, GANNON, KENNEY, GIGLIOTTI, FLEAGLE,
MARKOSEK, WOZNIAK, CAWLEY, ALLEN, M. N. WRIGHT, HENNESSEY,
BROWN, LEDERER, KELLER, KIRKLAND, ROONEY, ROBINSON, CLARK,
PETRONE, BAKER, FICHTER, WILLIAMS, SANTONI, OLIVER, FEE,
GEORGE, MUNDY, EVANS, CIVERA, STEIGHNER, COLAFELLA, RITTER,
ULIANA, PESCI, SURRA, E. Z. TAYLOR, CORRIGAN, JAMES, PETTIT,
CHADWICK, PERZEL, RUBLEY, PHILLIPS AND BEBKO-JONES,
FEBRUARY 8, 1993
AS REPORTED FROM COMMITTEE ON HEALTH AND WELFARE, HOUSE OF
REPRESENTATIVES, AS AMENDED, NOVEMBER 23, 1993
AN ACT
1 Providing for BIDDING ON pharmaceutical services in health <--
2 insurance policies and employee benefit plans and for the <--
3 rights of pharmacists and persons enrolled in health
4 insurance plans and employee benefit plans; and imposing
5 penalties.
6 The General Assembly of the Commonwealth of Pennsylvania
7 hereby enacts as follows:
8 Section 1. Short title.
9 This act shall be known and may be cited as the
10 Pharmaceutical Services Freedom of Choice Act. <--
11 Section 2. Definitions.
12 The following words and phrases when used in this act shall
1 have the meanings given to them in this section unless the
2 context clearly indicates otherwise:
3 "Licensed pharmacist." An individual duly licensed by the
4 State Board of Pharmacy to engage in the practice of pharmacy.
5 "Medical practitioner." A physician, dentist, veterinarian <--
6 or other individual duly authorized and licensed by law to
7 prescribe drugs.
8 "Person." An individual, partnership, corporation or
9 association or any other legal entity.
10 "Prescription." A written or oral order, issued by a duly
11 licensed medical practitioner in the course of his professional
12 practice, for a controlled substance or other drug, device or
13 medication which is dispensed for use by a consumer.
14 "Prescription drug." A drug supplied pursuant to a
15 prescription.
16 "Prescription drug benefit program." A program through which <--
17 a person enrolled in the program may obtain pharmaceutical
18 services, including prescription drugs, through payment by a
19 third-party entity.
20 "Provider contract." A contract or agreement providing
21 pharmaceutical services to a beneficiary, with payment made by a
22 third-party entity.
23 Section 3. Prohibited policy provisions.
24 No health insurance policy or employee benefit plan which is
25 executed, delivered, issued or otherwise contracted for in this
26 Commonwealth shall: <--
27 (1) Deny any licensed pharmacy or licensed pharmacist
28 the right to participate as a contracting provider for the
29 policy or plan upon the same terms and conditions as are
30 offered to any other pharmacy provider under the policy or
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1 plan.
2 (2) Prevent any person who is a party to or beneficiary
3 of any health insurance policy or employee benefit plan from
4 selecting a licensed pharmacy of his or her choice to furnish
5 the pharmaceutical services offered under the policy or plan,
6 provided that the pharmacy elects to participate as a
7 provider under the terms and conditions of the policy or
8 plan.
9 (3) Permit or mandate any difference in the copayment
10 fee charged to any person who is a party to or beneficiary of
11 any health insurance policy or employee benefit plan,
12 regardless of the provider selected by the person or party or
13 regardless of whether the prescription benefits are provided
14 through direct contact with the provider or by utilization of
15 a mail-order service. Further, no policy or plan shall
16 provide differences in coverage or impose any different
17 conditions upon any person who is a party to or beneficiary
18 of any policy or plan based upon the provider utilized or
19 whether a mail-order service is utilized. DENY ANY LICENSED <--
20 PHARMACY OR LICENSED PHARMACIST THE RIGHT TO BID ON A
21 PROVIDER CONTRACT FOR THE POLICY OR PLAN. IF A PROVIDER
22 CONTRACT IS TO BE RENEGOTIATED, BIDDING SHALL BE OPEN TO ANY
23 LICENSED PHARMACY OR LICENSED PHARMACIST.
24 Section 4. Unlawful acts.
25 After the effective date of this act, it shall be unlawful
26 for any health insurance policy or employee benefit plan
27 providing pharmacy services, including drugs, to require the
28 utilization of a specific licensed pharmacy whether located
29 within or outside of this Commonwealth. The policy or plan must <--
30 allow the beneficiary or employee the freedom to obtain the
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1 pharmaceutical services from any licensed pharmacy willing to
2 provide the services under the terms and conditions of the
3 insurance policy or employee benefit plan.
4 Section 5. Provisions in conflict with act.
5 (a) Contrary provisions void.--Any provision in a health
6 insurance policy or employee benefit plan which is executed,
7 delivered, renewed or otherwise contracted for in this
8 Commonwealth that is contrary to any provision of this act
9 shall, to the extent of such conflict, be void.
10 (b) Unlawful act.--It shall be unlawful for any insurer or
11 any person to provide any health insurance policy or employee
12 benefit plan providing for pharmaceutical services that does not
13 conform to the provisions of this act.
14 Section 6. Restriction on sale of insurance policies.
15 The Insurance Commissioner shall not approve for sale any
16 health insurance policy or employee benefit plan providing for
17 pharmaceutical services which does not conform to the provisions
18 of this act.
19 SECTION 7. PHARMACEUTICAL PRICING PROCEDURES. <--
20 TO ASSURE LOWEST POSSIBLE PRICES TO THE CONSUMER,
21 PHARMACEUTICAL MANUFACTURERS, WHOLESALERS, REPACKAGERS OR
22 DISTRIBUTORS OF PRESCRIPTION DRUGS AND MEDICAL SUPPLIES DOING
23 BUSINESS IN THIS COMMONWEALTH SHALL BE REQUIRED TO OFFER TO
24 EVERY PURCHASER OF EQUAL VOLUME OF THEIR PRODUCTS THE SAME
25 PRICE, CONDITIONS AND PRIVILEGES ACCORDED TO THE MOST FAVORED
26 PURCHASER.
27 Section 7 8. Enforcement by Insurance Commissioner. <--
28 It shall be the duty and responsibility of the Insurance
29 Commissioner to administer and enforce the provisions of this
30 act, and to promulgate necessary rules and regulations.
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1 Section 8 9. Penalties. <--
2 A person or entity who violates a provision of this act
3 commits a misdemeanor and shall, upon conviction, be sentenced
4 to pay a fine or not more than $5,000 or to imprisonment for not
5 more than one year, or both. For each subsequent conviction, the
6 violator shall be sentenced to pay a fine of not more than
7 $15,000 or to imprisonment for not more than three years, or
8 both.
9 Section 9 10. Repeals. <--
10 All acts and parts of acts are repealed insofar as they are
11 inconsistent with this act.
12 Section 10 11. Applicability. <--
13 This act shall apply to all health insurance and employee
14 benefit plans providing pharmaceutical services benefits,
15 including, without limitation, prescription drugs, to any
16 resident of this Commonwealth.
17 Section 11 12. Effective date. <--
18 This act shall take effect in 60 days.
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