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A07748
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
AS REPORTED FROM COMMITTEE ON HEALTH, HOUSE OF REPRESENTATIVES,
AS AMENDED, JUNE 12, 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 ORGANIZATION 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 UPON REQUEST 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) Any information disclosed or produced by a pharmacy
benefits manager or a medical assistance managed care
organization to the department under this section shall not be
subject to the act of February 14, 2008 (P.L.6, No.3), known as
the Right-to-Know Law.
(e) (f) As used in this section, the following words and
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phrases shall have the meanings given to them in this subsection
unless the context clearly indicates otherwise:
"PHARMACY BENEFITS MANAGEMENT." ANY OF THE FOLLOWING:
(1) PROCUREMENT OF PRESCRIPTION DRUGS AT A NEGOTIATED
CONTRACTED RATE FOR DISTRIBUTION WITHIN THIS COMMONWEALTH TO
COVERED INDIVIDUALS.
(2) ADMINISTRATION OR MANAGEMENT OF PRESCRIPTION DRUG
BENEFITS PROVIDED BY A COVERED ENTITY FOR THE BENEFIT OF
COVERED INDIVIDUALS.
(3) ADMINISTRATION OF PHARMACY BENEFITS, INCLUDING:
(I) OPERATING A MAIL-SERVICE PHARMACY.
(II) CLAIMS PROCESSING.
(III) MANAGING A RETAIL PHARMACY NETWORK MANAGEMENT.
(IV) PAYING CLAIMS TO PHARMACIES FOR PRESCRIPTION
DRUGS DISPENSED TO COVERED INDIVIDUALS VIA RETAIL OR
MAIL-ORDER PHARMACY.
(V) DEVELOPING AND MANAGING A CLINICAL FORMULARY,
UTILIZATION MANAGEMENT AND QUALITY ASSURANCE PROGRAMS.
(VI) REBATE CONTRACTING AND ADMINISTRATION.
(VII) MANAGING A PATIENT COMPLIANCE, THERAPEUTIC
INTERVENTION AND GENERIC SUBSTITUTION PROGRAM.
(VIII) OPERATING A DISEASE MANAGEMENT PROGRAM.
(IX) SETTING PHARMACY REIMBURSEMENT PRICING AND
METHODOLOGIES, INCLUDING MAXIMUM ALLOWABLE COST, AND
DETERMINING SINGLE OR MULTIPLE SOURCE DRUGS.
"Pharmacy benefits manager." A person, business or other
entity that performs pharmacy benefits management.
Section 2. This act shall take effect in 60 days.
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