PRINTER'S NO. 3642
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2212
Session of
2018
INTRODUCED BY HEFFLEY, PICKETT, DAVIS, McGINNIS, HENNESSEY,
OBERLANDER, WARD, HAGGERTY, FLYNN, NEILSON, MENTZER, TOEPEL,
CRUZ, DEASY, KAUFFMAN, J. McNEILL, DRISCOLL, GROVE, HILL-
EVANS, SAYLOR, HICKERNELL, COX, KEEFER, DeLUCA, FARRY,
PHILLIPS-HILL, ROTHMAN, HANNA, KLUNK, LONGIETTI, CHARLTON,
BARRAR, PEIFER, QUIGLEY, MATZIE, KORTZ, HELM, MEHAFFIE,
B. O'NEILL AND GREINER, JUNE 7, 2018
REFERRED TO COMMITTEE ON HEALTH, JUNE 7, 2018
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
providing for financial disclosures for pharmacy services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
Section 449.1. Financial Disclosures for Pharmacy
Services.--(a) Any pharmacy benefits manager that contracts
with a medical assistance managed care organization under
contract with the department shall be prohibited from utilizing
any confidentiality provisions which would in effect prohibit
disclosure of information to the medical assistance managed care
association and the department upon its request.
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(b) Requests by the department may include the payment
methodology for the pharmacy benefits manager which must include
the actual amount paid by the pharmacy benefits manager to a
pharmacy for dispensing an outpatient covered drug or medical
supply item, including, at a minimum, the ingredient cost and
dispensing fee and any other administrative fees.
(c) A medical assistance managed care organization that
assigns financial responsibility for determining the dispensing
pharmacy payment methodology, including the ingredient cost and
dispensing fee, shall disclose to the department all financial
terms and payment arrangements that apply between the medical
assistance managed care organization and the pharmacy benefits
manager annually and within ten days of any changes to the
financial terms and payment arrangements. For the purposes of
this act, a pharmacy benefits manager which contracts with a
medical assistance managed care organization shall maintain
records sufficient to provide information for pharmaceuticals
dispensed and paid for by medical assistance to the department,
including the information required under Chapter 7 of the act of
November 21, 2016 (P.L.1318, No.169), known as the Pharmacy
Audit Integrity and Transparency Act.
(d) The department shall promulgate regulations necessary to
establish an appeals process for pharmacies to utilize for
suspected violations of this section.
(e) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Pharmacy benefits manager." A person, business or other
entity that performs pharmacy benefits management.
Section 2. This act shall take effect in 60 days.
20180HB2212PN3642 - 2 -
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