SENATE AMENDED
PRIOR PRINTER'S NOS. 1748, 2922, 4049
PRINTER'S NO. 4574
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
941
Session of
2019
INTRODUCED BY HEFFLEY, MATZIE, NEILSON, WARNER, BURGOS, SAINATO,
FRANKEL, READSHAW, BARRAR, LONGIETTI, MILLARD, KEEFER, SIMS,
DeLUCA, BERNSTINE, MULLINS, CRUZ, WHEELAND, MARSHALL,
SCHWEYER, MOUL, BROWN, STRUZZI, KENYATTA, PYLE, McCLINTON,
DEASY, EVERETT, KNOWLES, SCHMITT, HERSHEY, KLUNK, T. DAVIS,
DUSH, FLYNN, BURNS, GREINER, KAUFFMAN, SAYLOR, SCHLOSSBERG,
RIGBY, McNEILL, KORTZ, OWLETT, MASSER, ISAACSON, GAYDOS,
QUINN, BOYLE, KOSIEROWSKI, PASHINSKI, MADDEN, WILLIAMS,
ULLMAN, THOMAS, STURLA, WENTLING, TOOHIL, GABLER, SOLOMON,
HARKINS AND POLINCHOCK, MAY 7, 2019
AS AMENDED ON THIRD CONSIDERATION, IN SENATE, OCTOBER 20, 2020
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,
further providing for medical assistance pharmacy services.
IN PUBLIC ASSISTANCE, FURTHER PROVIDING FOR MEDICAL
ASSISTANCE PHARMACY SERVICES AND PROVIDING FOR PRESCRIPTION
DRUG PRICING STUDY.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 449 of the act of June 13, 1967 (P.L.31,
No.21), known as the Human Services Code, is amended to read:
Section 449. Medical Assistance Pharmacy Services.--(a) Any
managed care [entity] organization under contract to the
department must contract on an equal basis with any pharmacy
qualified to participate in the Medical Assistance Program that
is willing to comply with the managed care [entity's]
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organization's pharmacy payment rates and terms and to adhere to
quality standards established by the managed care [entity]
organization.
(b) The department may conduct an audit or review of an
entity. In the course of an audit or review under this
subsection, a managed care organization utilizing a pharmacy
benefit manager shall provide medical assistance-specific
information from a pharmacy contract or agreement to the
department.
(c) A contract or agreement between an entity and a pharmacy
may not include any of the following:
(1) A confidentiality provision that prohibits the
disclosure of information to the department.
(2) Any provision that restricts the disclosure of
information to or communication with a managed care organization
or the department.
(d) An entity shall maintain records sufficient to disclose,
upon the department's request, information regarding the
provision of pharmacy services eligible for payment by the
medical assistance program.
(e) Information disclosed or produced by an entity to the
department under this section shall not be subject to QUALIFY AS
AN EXEMPTION UNDER SECTION 708 OF the act of February 14, 2008
(P.L.6, No.3), known as the Right-to-Know Law.
(f) If an entity approves a claim for payment under the
medical assistance program, the entity may not retroactively
deny or modify the payment unless any of the following apply:
(1) The claim was fraudulent.
(2) The claim was duplicative of a previously paid claim.
(3) The pharmacy did not dispense the pharmacy service on
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the claim.
(g) A managed care organization or pharmacy benefit manager
may not do any of the following:
(1) Mandate that a medical assistance recipient use a
specific pharmacy or other entity if any of the following apply:
(i) The managed care organization or pharmacy benefit
manager has an ownership interest in the pharmacy or other
entity.
(ii) The pharmacy or other entity has an ownership interest
in the managed care organization or pharmacy benefit manager.
(2) Provide an incentive to a medical assistance recipient
to encourage the use of a specific pharmacy.
(h) A pharmacy benefit manager or pharmacy services
administration organization may not do any of the following:
(1) Require that a pharmacist or pharmacy participate in a
network managed by the pharmacy benefit manager or pharmacy
services administration organization as a condition for the
pharmacist or pharmacy to participate in another network managed
by the same pharmacy benefit manager or pharmacy services
administration organization.
(2) A utomatically enroll or disenroll a pharmacist or
pharmacy without cause in a contract or modify an existing
agreement without written agreement of the pharmacist or
pharmacy.
(3) Charge or retain a differential between what is billed
to a managed care organization as a reimbursement for a pharmacy
service and what is paid to pharmacies by the pharmacy benefit
manager or pharmacy services administration organization for the
pharmacy service.
(4) Charge pharmacy transmission fees.
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(i) (F) A managed care organization or pharmacy benefit
manager shall provide payment for a pharmacy service that is a
covered benefit if the pharmacy service is performed by a
licensed pharmacist in accordance with all of the following:
(1) The pharmacy service performed is within the scope of
practice of the licensed pharmacist.
(2) The managed care organization or pharmacy benefit
manager would cover the pharmacy service if the pharmacy service
was performed by a physician, an advanced practice registered
nurse or a physician assistant . AS DETERMINED BY THE FEE
SCHEDULE PUBLISHED BY THE DEPARTMENT.
(G) BEGINNING JANUARY 1, 2021, FOR EACH PRESCRIPTION FILLED,
A PARTICIPATING PHARMACY SHALL RECEIVE REIMBURSEMENT FOR DRUG
COST AT A RATE NO LESS THAN THE COST OF THE DRUG PRODUCT AS
GENERALLY AVAILABLE TO RETAIL PHARMACIES, UTILIZING AN AVERAGE
ACQUISITION COST REIMBURSEMENT METHODOLOGY, AND AFTER ANY
PHARMACY BENEFIT MANAGER OR PAYER ADJUSTMENT TO THAT DRUG COST.
THE PHARMACY SHALL ALSO RECEIVE A REASONABLE PROFESSIONAL
DISPENSING FEE FOR EACH PRESCRIPTION FILLED AS DETERMINED BY THE
DEPARTMENT.
(j) (H) As used in this section, the following words and
phrases shall have the meanings given to them in this
subsection:
"Entity" means a pharmacy, pharmacy benefit manager, pharmacy
services administration organization or other entity that
manages, processes, influences the payment for or dispenses
pharmacy services to medical assistance recipients in the
managed care delivery system.
"Pharmacy benefit management" means any of the following:
(1) The procurement of prescription drugs at a negotiated
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contracted rate for distribution within this Commonwealth.
(2) The administration or management of prescription drug
benefits provided by a managed care organization.
(3) The administration of pharmacy benefits, including any
of the following:
(i) Operating a mail-service pharmacy.
(ii) Processing claims.
(iii) Managing a retail pharmacy network.
(iv) Paying claims to pharmacies, including retail,
specialty or mail-order pharmacies, for prescription drugs
dispensed to medical assistance recipients receiving services in
the managed care delivery system via a retail or mail-order
pharmacy.
(v) Developing and managing a clinical formulary or
preferred drug list, utilization management or 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 payment pricing and methodologies,
including maximum allowable cost and determining single or
multiple source drugs.
"Pharmacy benefit manager" means a person, business or other
entity that performs pharmacy benefit management. The term
includes a wholly-owned subsidiary of a managed care
organization that performs pharmacy benefits management. THE
TERM DOES NOT INCLUDE AN ENTITY THAT HOLDS A VALID LICENSE FROM
THE INSURANCE DEPARTMENT WITH ACCIDENT AND HEALTH AUTHORITY TO
ISSUE A HEALTH INSURANCE POLICY AND GOVERNED UNDER ANY OF THE
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FOLLOWING:
(1) THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS THE
INSURANCE COMPANY LAW OF 1921.
(2) THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364), KNOWN
AS THE HEALTH MAINTENANCE ORGANIZATION ACT.
(3) 40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
CORPORATIONS) OR 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
PLAN CORPORATIONS).
"Pharmacy services administration organization" means a
person, business or other entity that performs any of the
following:
(1) Negotiates or contracts with a managed care organization
or pharmacy benefit manager on behalf of its pharmacy members.
(2) Negotiates payment rates, payments or audit terms on
behalf of its pharmacy members.
(3) Collects or reconciles payments on behalf of its
pharmacy members.
Section 2. The amendment of section 449 of the act shall
apply to any agreement or contract relating to pharmacy services
to medical assistance recipients in the managed care delivery
system entered into or amended on or after the effective date of
this section.
Section 3. This act shall take effect in 60 days.
SECTION 1. SECTION 449 OF THE ACT OF JUNE 13, 1967 (P.L.31,
NO.21), KNOWN AS THE HUMAN SERVICES CODE, IS AMENDED TO READ:
SECTION 449. MEDICAL ASSISTANCE PHARMACY SERVICES.--(A) ANY
MANAGED CARE [ENTITY] ORGANIZATION UNDER CONTRACT TO THE
DEPARTMENT, OR AN ENTITY WITH WHICH THE MANAGED CARE
ORGANIZATION CONTRACTS, MUST CONTRACT ON AN EQUAL BASIS WITH ANY
PHARMACY QUALIFIED TO PARTICIPATE IN THE MEDICAL ASSISTANCE
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PROGRAM THAT IS WILLING TO COMPLY WITH THE MANAGED CARE
[ENTITY'S] ORGANIZATION'S OR ENTITY'S PHARMACY PAYMENT RATES AND
TERMS AND TO ADHERE TO QUALITY STANDARDS ESTABLISHED BY THE
MANAGED CARE [ENTITY] ORGANIZATION OR ENTITY.
(B) THE FOLLOWING SHALL APPLY:
(1) THE DEPARTMENT MAY CONDUCT AN AUDIT OR REVIEW OF AN
ENTITY FOR THE PURPOSE OF DETERMINING COMPLIANCE WITH THIS
SECTION.
(2) IN THE COURSE OF AN AUDIT OR REVIEW UNDER PARAGRAPH (1),
AN ENTITY SHALL PROVIDE MEDICAL ASSISTANCE-SPECIFIC INFORMATION
FROM A PHARMACY CONTRACT OR AGREEMENT TO THE DEPARTMENT.
(C) A CONTRACT OR AGREEMENT BETWEEN AN ENTITY AND A PHARMACY
MAY NOT INCLUDE ANY OF THE FOLLOWING:
(1) A CONFIDENTIALITY PROVISION THAT PROHIBITS THE
DISCLOSURE OF INFORMATION TO THE DEPARTMENT.
(2) ANY PROVISION THAT RESTRICTS THE DISCLOSURE OF
INFORMATION TO OR COMMUNICATION WITH A MANAGED CARE ORGANIZATION
OR THE DEPARTMENT.
(D) AN ENTITY SHALL MAINTAIN RECORDS REGARDING PHARMACY
SERVICES ELIGIBLE FOR PAYMENT BY THE MEDICAL ASSISTANCE PROGRAM
AND SHALL DISCLOSE THE INFORMATION TO THE DEPARTMENT UPON ITS
REQUEST.
(E) INFORMATION DISCLOSED OR PRODUCED BY AN ENTITY TO THE
DEPARTMENT UNDER THIS SECTION SHALL NOT BE SUBJECT TO PUBLIC
ACCESS UNDER THE ACT OF FEBRUARY 14, 2008 (P.L.6, NO.3), KNOWN
AS THE "RIGHT-TO-KNOW LAW."
(F) THE FOLLOWING SHALL APPLY:
(1) IF AN ENTITY APPROVES A CLAIM FOR PAYMENT UNDER THE
MEDICAL ASSISTANCE PROGRAM, THE ENTITY MAY NOT RETROACTIVELY
DENY OR MODIFY THE ADJUDICATED CLAIM UNLESS ANY OF THE FOLLOWING
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APPLY:
(I) THE CLAIM WAS FRAUDULENT.
(II) THE CLAIM WAS DUPLICATIVE OF A PREVIOUSLY PAID CLAIM.
(III) THE PHARMACY DID NOT DISPENSE THE PHARMACY SERVICE ON
THE CLAIM.
(2) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO
PROHIBIT THE RECOVERY OF AN ADJUDICATED CLAIM THAT WAS
DETERMINED TO BE AN OVERPAYMENT OR UNDERPAYMENT RESULTING FROM
AUDIT, REVIEW OR INVESTIGATION BY A FEDERAL OR STATE AGENCY OR
MANAGED CARE ORGANIZATION.
(G) A MANAGED CARE ORGANIZATION OR PHARMACY BENEFIT MANAGER
MAY NOT MANDATE THAT A MEDICAL ASSISTANCE RECIPIENT USE A
SPECIFIC PHARMACY UNLESS IT IS CONSISTENT WITH SUBSECTION (A)
AND IS PREAPPROVED BY THE DEPARTMENT.
(H) A PHARMACY BENEFIT MANAGER OR PHARMACY SERVICES
ADMINISTRATION ORGANIZATION MAY NOT DO ANY OF THE FOLLOWING:
(1) REQUIRE THAT A PHARMACIST OR PHARMACY PARTICIPATE IN A
NETWORK MANAGED BY THE PHARMACY BENEFIT MANAGER OR PHARMACY
SERVICES ADMINISTRATION ORGANIZATION AS A CONDITION FOR THE
PHARMACIST OR PHARMACY TO PARTICIPATE IN ANOTHER NETWORK MANAGED
BY THE SAME PHARMACY BENEFIT MANAGER OR PHARMACY SERVICES
ADMINISTRATION ORGANIZATION.
(2) AUTOMATICALLY ENROLL OR DISENROLL A PHARMACIST OR
PHARMACY WITHOUT CAUSE.
(3) CHARGE OR RETAIN A DIFFERENTIAL BETWEEN WHAT IS BILLED
TO A MANAGED CARE ORGANIZATION AS A REIMBURSEMENT FOR A PHARMACY
SERVICE AND WHAT IS PAID TO PHARMACIES BY THE PHARMACY BENEFIT
MANAGER OR PHARMACY SERVICES ADMINISTRATION ORGANIZATION FOR THE
PHARMACY SERVICE.
(4) CHARGE PHARMACY TRANSMISSION FEES UNLESS THE AMOUNT OF
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THE FEE IS DISCLOSED AND APPLIED AT THE TIME OF CLAIM
ADJUDICATION.
(I) A MANAGED CARE ORGANIZATION SHALL SUBMIT ITS POLICIES
AND PROCEDURES, AND ANY REVISIONS, FOR DEVELOPMENT OF NETWORK
PHARMACY PAYMENT METHODOLOGY TO THE DEPARTMENT. THE DEPARTMENT
SHALL REVIEW ALL CHANGES TO PHARMACY PAYMENT METHODOLOGY PRIOR
TO IMPLEMENTATION.
(J) A MANAGED CARE ORGANIZATION UTILIZING A PHARMACY BENEFIT
MANAGER SHALL REPORT TO THE DEPARTMENT INFORMATION RELATED TO
EACH OUTPATIENT DRUG ENCOUNTER, INCLUDING THE FOLLOWING:
(1) THE AMOUNT PAID TO THE PHARMACY BENEFIT MANAGER BY THE
MANAGED CARE ORGANIZATION.
(2) THE AMOUNT PAID BY THE PHARMACY BENEFIT MANAGER TO THE
PHARMACY.
(3) ANY DIFFERENCES BETWEEN THE AMOUNT PAID IN PARAGRAPH (1)
AND THE AMOUNT PAID IN PARAGRAPH (2).
(4) OTHER INFORMATION AS REQUESTED BY THE DEPARTMENT.
(K) A PHARMACY SHALL, UPON REQUEST, SUBMIT THE ACTUAL
ACQUISITION COST OF PRESCRIPTIONS DISPENSED TO MEDICAL
ASSISTANCE BENEFICIARIES.
(L) AS USED IN THIS SECTION, THE FOLLOWING WORDS AND PHRASES
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SUBSECTION:
"ADJUDICATED CLAIM" MEANS A CLAIM THAT HAS BEEN PROCESSED TO
PAYMENT OR DENIAL.
"ENTITY" MEANS A PHARMACY, PHARMACY BENEFIT MANAGER, PHARMACY
SERVICES ADMINISTRATION ORGANIZATION OR OTHER ENTITY THAT
MANAGES, PROCESSES, OR INFLUENCES THE PAYMENT FOR OR DISPENSES
PHARMACY SERVICES TO MEDICAL ASSISTANCE RECIPIENTS IN THE
MANAGED CARE DELIVERY SYSTEM.
"PHARMACY BENEFIT MANAGEMENT" MEANS ANY OF THE FOLLOWING:
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(1) THE PROCUREMENT OF PRESCRIPTION DRUGS AT A NEGOTIATED
CONTRACTED RATE FOR DISTRIBUTION WITHIN THIS COMMONWEALTH.
(2) THE ADMINISTRATION OR MANAGEMENT OF PRESCRIPTION DRUG
BENEFITS PROVIDED BY A MANAGED CARE ORGANIZATION.
(3) THE ADMINISTRATION OF PHARMACY BENEFITS, INCLUDING ANY
OF THE FOLLOWING:
(I) OPERATING A MAIL-SERVICE PHARMACY.
(II) PROCESSING CLAIMS.
(III) MANAGING A RETAIL PHARMACY NETWORK.
(IV) PAYING CLAIMS TO PHARMACIES, INCLUDING RETAIL,
SPECIALTY OR MAIL-ORDER PHARMACIES, FOR PRESCRIPTION DRUGS
DISPENSED TO MEDICAL ASSISTANCE RECIPIENTS RECEIVING SERVICES IN
THE MANAGED CARE DELIVERY SYSTEM VIA A RETAIL OR MAIL-ORDER
PHARMACY.
(V) DEVELOPING AND MANAGING A CLINICAL FORMULARY OR
PREFERRED DRUG LIST, UTILIZATION MANAGEMENT OR 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 PAYMENT PRICING AND METHODOLOGIES,
INCLUDING MAXIMUM ALLOWABLE COST AND DETERMINING SINGLE OR
MULTIPLE SOURCE DRUGS.
"PHARMACY BENEFIT MANAGER" MEANS A BUSINESS THAT PERFORMS
PHARMACY BENEFIT MANAGEMENT. THE TERM DOES NOT INCLUDE A
BUSINESS THAT HOLDS A VALID LICENSE FROM THE INSURANCE
DEPARTMENT WITH ACCIDENT AND HEALTH AUTHORITY TO ISSUE A HEALTH
INSURANCE POLICY AND GOVERNED UNDER ANY OF THE FOLLOWING:
(1) THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS "THE
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INSURANCE COMPANY LAW OF 1921."
(2) THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364), KNOWN
AS THE "HEALTH MAINTENANCE ORGANIZATION ACT."
(3) 40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
CORPORATIONS) OR 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
PLAN CORPORATIONS).
"PHARMACY SERVICES ADMINISTRATION ORGANIZATION" MEANS AN
ORGANIZATION COMPRISED OF PHARMACY MEMBERS THAT PERFORMS ANY OF
THE FOLLOWING:
(1) NEGOTIATES OR CONTRACTS WITH A MANAGED CARE ORGANIZATION
OR PHARMACY BENEFIT MANAGER ON BEHALF OF ITS PHARMACY MEMBERS.
(2) NEGOTIATES PAYMENT RATES, PAYMENTS OR AUDIT TERMS ON
BEHALF OF ITS PHARMACY MEMBERS.
(3) COLLECTS OR RECONCILES PAYMENTS ON BEHALF OF ITS
PHARMACY MEMBERS.
SECTION 2. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
SECTION 449.1. PRESCRIPTION DRUG PRICING STUDY.--(A) THE
LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL CONDUCT A STUDY
ANALYZING PRESCRIPTION DRUG PRICING UNDER THE MEDICAL ASSISTANCE
MANAGED CARE PROGRAM. THE COMMITTEE SHALL DO ALL OF THE
FOLLOWING AS IT RELATES TO THE MEDICAL ASSISTANCE MANAGED CARE
PROGRAM ONLY:
(1) PROVIDE AN OVERVIEW OF THE DISTRIBUTION OF AND PAYMENT
FOR PHARMACEUTICALS IN THE MEDICAL ASSISTANCE MANAGED CARE
PROGRAM.
(2) REVIEW THE REIMBURSEMENT PRACTICES OF PHARMACY BENEFIT
MANAGERS TO PHARMACIES WITHIN THIS COMMONWEALTH.
(3) REVIEW THE REIMBURSEMENT PRACTICES OF MANAGED CARE
ORGANIZATIONS TO PHARMACY BENEFIT MANAGERS.
(4) INVESTIGATE AND COMPARE THE REIMBURSEMENT RATES PAID BY
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PHARMACY BENEFIT MANAGERS TO INDEPENDENT PHARMACIES AND TO CHAIN
PHARMACIES.
(5) STUDY THE BEST PRACTICES AND LAWS ADOPTED BY OTHER
STATES TO ADDRESS CONCERNS WITH PHARMACY REIMBURSEMENT PRACTICES
OF PHARMACY BENEFIT MANAGERS.
(B) THE LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL
REVIEW AND UTILIZE DATA FROM THE MOST RECENT TWELVE-MONTH
PERIOD.
(C) THE DEPARTMENT SHALL PROVIDE THE FOLLOWING DATA TO THE
LEGISLATIVE BUDGET AND FINANCE COMMITTEE:
(1) THE AMOUNT PAID TO A PHARMACY PROVIDER PER CLAIM,
INCLUDING INGREDIENT COST AND THE AMOUNT OF ANY COPAYMENT
DEDUCTED FROM THE PAYMENT.
(2) THE TRANSMISSION FEES CHARGED BY A PHARMACY BENEFIT
MANAGER TO A PHARMACY PROVIDER.
(3) THE AMOUNT CHARGED BY THE PHARMACY BENEFIT MANAGER TO
THE MEDICAL ASSISTANCE MANAGED CARE ORGANIZATION PER CLAIM,
INCLUDING ALL ADMINISTRATIVE FEES AND PROCESSING CHARGES
ASSOCIATED WITH THE CLAIM.
(4) REBATES PAID BY THE PHARMACY BENEFIT MANAGER TO THE
MANAGED CARE ORGANIZATION.
(5) ANY OTHER DATA THE LEGISLATIVE BUDGET AND FINANCE
COMMITTEE DEEMS NECESSARY.
(D) PHARMACY BENEFIT MANAGERS AND MEDICAL ASSISTANCE MANAGED
CARE ORGANIZATIONS SHALL PROVIDE THE REQUIRED DATA UNDER
SUBSECTION (C) TO THE DEPARTMENT WITHIN 45 DAYS OF THE EFFECTIVE
DATE OF THIS SECTION FOR DISTRIBUTION TO THE LEGISLATIVE BUDGET
AND FINANCE COMMITTEE. THE PROVIDING OF DATA BY THE PHARMACY
BENEFIT MANAGERS AND MEDICAL ASSISTANCE MANAGED CARE
ORGANIZATIONS TO DEPARTMENT OR BY THE DEPARTMENT TO THE
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LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL NOT CONSTITUTE A
WAIVER OF ANY APPLICABLE PRIVILEGE OR CLAIM OF CONFIDENTIALITY.
ALL DATA SHALL BE GIVEN CONFIDENTIAL TREATMENT, SHALL NOT BE
SUBJECT TO SUBPOENA BY A THIRD PARTY ENTITY AND MAY NOT BE MADE
PUBLIC OR OTHERWISE SHARED BY THE DEPARTMENT, THE LEGISLATIVE
BUDGET AND FINANCE COMMITTEE OR ANY OTHER PERSON EXCEPT TO THE
EXTENT ALLOWED UNDER THIS SUBSECTION.
(E) ALL DATA PROVIDED UNDER SUBSECTION (B) FOR PURPOSES OF
CONDUCTING THE STUDY SHALL BE IN A FORM THAT IS DE-IDENTIFIED OF
PERSONAL HEALTH INFORMATION.
(F) THE LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL
PUBLISH ONLY AGGREGATE DATA IN THE REPORT. ANY INFORMATION
DISCLOSED OR PRODUCED BY A PHARMACY BENEFIT MANAGER OR A MEDICAL
ASSISTANCE MANAGED CARE ORGANIZATION FOR THE PURPOSES OF THIS
STUDY SHALL BE CONFIDENTIAL AND NOT BE SUBJECT TO THE ACT OF
FEBRUARY 14, 2008 (P.L.6, NO.3), KNOWN AS THE "RIGHT-TO-KNOW
LAW."
(G) THE LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL
SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDATIONS FOR
LEGISLATIVE ACTION TO THE GENERAL ASSEMBLY AND THE DEPARTMENT
WITHIN TWELVE MONTHS OF THE RECEIPT OF THE DATA FROM THE
DEPARTMENT IN SUBSECTION (C).
(H) AS USED IN THIS SECTION, THE FOLLOWING WORDS AND PHRASES
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SUBSECTION:
"ADJUDICATED CLAIM" SHALL HAVE THE SAME MEANING AS THE TERM
DOES IN SECTION 449.
"ENTITY" SHALL HAVE THE SAME MEANING AS THE TERM DOES IN
SECTION 449.
"PHARMACY BENEFIT MANAGEMENT" SHALL HAVE THE SAME MEANING AS
THE TERM DOES IN SECTION 449.
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"PHARMACY BENEFIT MANAGER" SHALL HAVE THE SAME MEANING AS THE
TERM DOES IN SECTION 449.
"PHARMACY SERVICES ADMINISTRATION ORGANIZATION" SHALL HAVE
THE SAME MEANING AS THE TERM DOES IN SECTION 449.
SECTION 3. THE AMENDMENT OF SECTION 449 OF THE ACT SHALL
APPLY TO ANY AGREEMENT OR CONTRACT RELATING TO PHARMACY SERVICES
TO MEDICAL ASSISTANCE RECIPIENTS IN THE MANAGED CARE DELIVERY
SYSTEM ENTERED INTO OR AMENDED ON OR AFTER THE EFFECTIVE DATE OF
THIS SECTION.
SECTION 4. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
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