PRINTER'S NO. 992
No. 15 Session of 2007
INTRODUCED BY COSTA, STACK, TARTAGLIONE, KASUNIC, KITCHEN,
MELLOW, MUSTO AND FUMO, MAY 8, 2007
REFERRED TO PUBLIC HEALTH AND WELFARE, MAY 8, 2007
AN ACT
1 Amending Title 40 (Insurance) of the Pennsylvania Consolidated
2 Statutes, providing for drug retail price registry.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Title 40 of the Pennsylvania Consolidated
6 Statutes is amended by adding a part to read:
7 PART IV
8 HEALTH CARE REFORM
9 Chapter
10 71. (Reserved)
11 72. Affordability
12 73. (Reserved)
13 74. (Reserved)
14 75. Miscellaneous Provisions
15 CHAPTER 71
16 (RESERVED)
17 CHAPTER 72
1 AFFORDABILITY
2 Sec.
3 7201. (Reserved).
4 7202. (Reserved).
5 7203. (Reserved).
6 7204. (Reserved).
7 7205. (Reserved).
8 7206. (Reserved).
9 7207. (Reserved).
10 7207. (Reserved).
11 7208. (Reserved).
12 7209. Transparency in price and quality for consumers.
13 § 7201. (Reserved).
14 § 7202. (Reserved).
15 § 7203. (Reserved).
16 § 7204. (Reserved).
17 § 7205. (Reserved).
18 § 7206. (Reserved).
19 § 7207. (Reserved).
20 § 7208. (Reserved).
21 § 7209. Transparency in price and quality for consumers.
22 (a) The Pennsylvania Drug Retail Price Registry.--
23 (1) The council shall establish and maintain a registry
24 to be known as the Pennsylvania Drug Retail Price Registry
25 for the purpose of making retail price information for the
26 150-most-frequently prescribed prescription drugs, together
27 with their generic equivalents where applicable, readily
28 available to consumers in this Commonwealth.
29 (i) The drug price registry shall include the
30 information submitted to the council under this
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1 subsection and the name and address of each pharmacy
2 providing the information and shall be organized by zip
3 code.
4 (ii) The drug price registry shall be updated
5 monthly by the council and shall be posted on the
6 council's Internet website in a format that is conducive
7 to review and comparison by consumers of prescription
8 drug retail prices charged by pharmacies in each zip code
9 within this Commonwealth. It shall include a toll-free
10 telephone number maintained by the council that consumers
11 may call to obtain reprints of the registry.
12 (iii) The website shall be designed so that the
13 consumer may download and print the displayed information
14 and shall include at least the following:
15 (A) Internet web links to other government
16 resources that provide information relating to the
17 regulation of prescription drugs and Federal and
18 State health care coverage and pharmaceutical
19 assistance programs.
20 (B) An advisory statement alerting consumers of
21 the need to tell their health care practitioner and
22 pharmacist about all the medications they may be
23 taking and to ask them how to avoid harmful
24 interactions between those drugs, if any.
25 (C) Clearly understandable language that is
26 designed to assist consumers in understanding the
27 content of and how to access the information made
28 available on the website pursuant to this subsection.
29 (2) Within 30 days following the effective date of this
30 section, the director of PACE shall determine and submit to
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1 the Pennsylvania Bulletin for publication a list of the 150-
2 most-frequently prescribed prescription drugs in this
3 Commonwealth and their generic equivalents and the unit
4 amount to be used for price reporting purposes. The list
5 shall be updated by the director of PACE annually thereafter,
6 and each such update shall be submitted to the Legislative
7 Reference Bureau for publication as a notice in the
8 Pennsylvania Bulletin.
9 (3) Every pharmacy selling pharmaceuticals at retail in
10 this Commonwealth shall submit to the council for inclusion
11 in the drug price registry, in a form and manner prescribed
12 by the council, on the 10th day of each calendar month
13 beginning with the first calendar month following publication
14 of the list described in paragraph (2), its prior monthly
15 retail prices for each drug on the list and its generic
16 equivalent, together with the amount of the dispensing fee.
17 In addition, each such pharmacy shall make the list and its
18 prices available to its customers at the pharmacy retail site
19 upon request.
20 (i) Each pharmacy retail site shall post a sign that
21 notifies customers of the availability of its price list
22 in a conspicuous location that is either at or adjacent
23 to the place where prescriptions are presented for
24 compounding and dispensing, in the customer waiting area
25 or in the area where prescribed drugs are delivered.
26 (ii) The provisions of this paragraph shall not be
27 construed to prevent a pharmacy from changing its current
28 retail price at any time, provided that the listed price
29 available at the pharmacy retail site is updated at least
30 weekly to reflect the new retail price.
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1 (4) The State Board of Pharmacy may impose a fine of up
2 to $1,000 per day for each day that a pharmacy fails to
3 comply with any of the provisions of this paragraph. A
4 separate fine may be imposed for each failure to comply. All
5 fines shall be due 30 days from receipt of notice of each
6 such failure. Funds collected pursuant to this paragraph
7 shall be deposited into the CAP Fund.
8 (b) The Pennsylvania Hospital Payment Registry.--
9 (1) The council shall also establish and maintain a
10 registry to be known as the Pennsylvania Hospital Payment
11 Registry for the purpose of making readily available to
12 consumers information regarding the payments received by
13 hospitals for the 150-most-frequent admission diagnoses and
14 the 150-most-frequently dispensed drugs.
15 (i) The hospital payment registry shall include the
16 information submitted to the council under this
17 subsection and the name and address of each hospital
18 providing the information and shall be organized by zip
19 code.
20 (ii) The hospital payment registry shall be updated
21 annually by the council and shall be posted on the
22 council's Internet website in a format that is conducive
23 to review and comparison by consumers of reimbursement
24 data from hospitals in each zip code of this
25 Commonwealth. It shall include a toll-free telephone
26 number maintained by the council that consumers may call
27 to obtain reprints of the registry.
28 (iii) The website shall be designed so that the
29 consumer may download and print the displayed information
30 and shall include at least the following:
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1 (A) Internet web links to other government
2 resources that provide information relating to the
3 regulation of hospitals and health insurance.
4 (B) Clearly understandable language that is
5 designed to assist consumers in understanding the
6 content of and how to access the information made
7 available on the website pursuant to this subsection.
8 (iv) The information on the hospital payment
9 registry may be combined with other data collected by the
10 council and posted on the council's Internet website to
11 provide comparative information useful to consumers
12 selecting a hospital for medical care.
13 (2) Within 90 days following the effective date of this
14 section and on or before January 31 of each year thereafter,
15 all hospitals shall submit to the council for inclusion in
16 the hospital payment registry, in a form and manner
17 prescribed by the council, all of the following:
18 (i) The 150-most-frequent admission diagnoses and
19 the 150-most-frequently dispensed drugs (both
20 prescription and nonprescription) in the hospital during
21 the preceding year.
22 (ii) The amount an individual enrolled in a high
23 deductible health plan with a health savings account is
24 required to pay for the diagnoses and drugs described in
25 subparagraph (i).
26 (iii) The average payment the hospital has
27 negotiated with third-party payers for the diagnoses and
28 drugs described in subparagraph (i).
29 (iv) The amount an uninsured patient is charged for
30 the diagnoses and drugs described in subparagraph (i).
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1 (3) A hospital shall make the list and payments received
2 available to its patients at the hospital site upon request.
3 The hospital shall post a sign that notifies patients of the
4 availability of the list at or adjacent to the place where
5 patients are admitted to the hospital and at the place where
6 patients receive financial counseling.
7 (c) The Pennsylvania Outpatient Procedure Payment
8 Registry.--
9 (1) The council shall also establish and maintain a
10 registry to be known as the Pennsylvania Outpatient Procedure
11 Payment Registry for the purpose of making readily available
12 to consumers information regarding the payments received by
13 ambulatory surgical facilities and imaging centers for the
14 50-most-frequent outpatient procedures.
15 (i) The outpatient procedure payment registry shall
16 include the information submitted to the council under
17 this subsection and the name and address of each
18 outpatient facility providing the information and shall
19 be organized by zip code.
20 (ii) The outpatient procedure payment registry shall
21 be updated annually by the council and shall be posted on
22 the council's Internet website in a format that is
23 conducive to review and comparison by consumers of
24 reimbursement data from outpatient facilities in each zip
25 code of this Commonwealth. It shall include a toll-free
26 telephone number maintained by the council that consumers
27 may call to obtain reprints of the registry.
28 (iii) The website shall be designed so that the
29 consumer may download and print the displayed information
30 and shall include at least the following:
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1 (A) Internet web links to other government
2 resources that provide information relating to the
3 regulation of outpatient facilities and health
4 insurance.
5 (B) Clearly understandable language that is
6 designed to assist consumers in understanding the
7 content of and how to access the information made
8 available on the website pursuant to this subsection.
9 (iv) The information on the outpatient procedure
10 payment registry may be combined with other data
11 collected by the council and posted on the council's
12 Internet website to provide comparative information
13 useful to consumers selecting a provider of medical care.
14 (2) Within 90 days following the effective date of this
15 section and on or before January 31 of each year thereafter,
16 all ambulatory surgical facilities and all imaging centers
17 shall submit to the council for inclusion in the outpatient
18 procedure payment registry, in a form and manner prescribed
19 by the council, the 50-most-frequent procedures performed at
20 the ambulatory surgical facility or imaging center during the
21 preceding year, the charge for each such procedure and the
22 average third-party reimbursement for each such procedure.
23 (3) The council, in consultation with the Department of
24 Health, may determine that the same information should be
25 obtained from other health care providers that primarily
26 perform outpatient procedures other than for primary or
27 chronic care, and, 90 days following publication of notice in
28 the Pennsylvania Bulletin, those health care providers shall
29 submit to the council for inclusion in the outpatient
30 procedure payment registry the information set forth in
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1 paragraph (2).
2 (d) Guidelines.--The council may adopt guidelines to
3 effectuate the purposes of this section.
4 (e) Enforcement.--In addition to any other remedy available,
5 the council may impose a civil penalty of up to $500 per day for
6 each failure of a facility to provide the council the
7 information required under this section. All fines collected
8 under this subsection shall be deposited in the CAP Fund.
9 CHAPTER 73
10 (RESERVED)
11 CHAPTER 74
12 (RESERVED)
13 CHAPTER 75
14 MISCELLANEOUS PROVISIONS
15 Sec.
16 7501. Regulations.
17 7502. Enforcement.
18 7503. Severability.
19 § 7501. Regulations.
20 (a) Regulations promulgated under this part.--Except as
21 otherwise provided in this part, the promulgation of regulations
22 under this part by Commonwealth agencies given the authority to
23 promulgate regulations shall, until three years from the
24 effective date of this section, be exempt from the following:
25 (1) Section 205 of the Commonwealth Documents Law.
26 (2) The Commonwealth Attorneys Act.
27 (3) The Regulatory Review Act.
28 (b) Other regulations.--If, in the determination of the head
29 of a Commonwealth agency given authority to promulgate
30 regulations under this part, rulemaking is needed for purposes
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1 of the safety of patients in this Commonwealth, the Commonwealth
2 agency may promulgate a final-omitted regulation under the
3 Regulatory Review Act.
4 § 7502. Enforcement.
5 (a) Determination of violation.--Upon a determination that a
6 person licensed by the Insurance Department has violated any
7 provision of this part, the department may, subject to 2 Pa.C.S.
8 Chs. 5 Subch. A (relating to practice and procedure of
9 Commonwealth agencies) and 7 Subch. A (relating to judicial
10 review of Commonwealth agency action) do any of the following:
11 (1) Issue an order requiring the person to cease and
12 desist from engaging in the violation.
13 (2) Suspend or revoke or refuse to issue or renew the
14 certificate or license of the offending party or parties.
15 (3) Impose an administrative penalty of up to $5,000 for
16 each violation.
17 (4) Seek restitution.
18 (5) Impose any other penalty or pursue any other remedy
19 deemed appropriate by the commissioner.
20 (b) Other remedies.--The enforcement remedies imposed under
21 this section are in addition to any other remedies or penalties
22 which be imposed by any other applicable statute, including the
23 act of July 22, 1974 (P.L.589, No.205), known as the Unfair
24 Insurance Practices Act. A violation by any person of this part
25 is deemed an unfair method of competition and an unfair or
26 deceptive act or practice under the Unfair Insurance Practices
27 Act.
28 (c) No private cause of action.--Nothing in this part shall
29 be construed as to create or imply a private cause of action for
30 violation of this part.
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1 § 7503. Severability.
2 (a) General rule.--The provisions of this part are
3 severable. If any provision of this part or its application to
4 any person or circumstance is held invalid, the invalidity shall
5 not affect other provisions or applications of this part which
6 can be given effect without the invalid provision or
7 application.
8 (b) (Reserved).
9 (c) (Reserved).
10 Section 2. This act shall take effect in 60 days.
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