SENATE AMENDED
PRIOR PRINTER'S NOS. 1587, 2089, 3655
PRINTER'S NO. 4053
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
943
Session of
2019
INTRODUCED BY GAYDOS, RAPP, BARRAR, BERNSTINE, BROWN, SCHLEGEL
CULVER, DeLUCA, HERSHEY, KAUFFMAN, KEEFER, MILLARD,
B. MILLER, MIZGORSKI, MOUL, MULLINS, PASHINSKI, PICKETT,
PYLE, SAINATO, SCHWEYER, SIMS, STRUZZI, STURLA, TOEPEL,
WHEELAND, LONGIETTI, GLEIM, KNOWLES, CIRESI, BURNS, DEASY,
MATZIE, SCHMITT, EVERETT, KLUNK, READSHAW, GREINER, DUSH,
SAYLOR, SCHLOSSBERG, HEFFLEY, RIGBY, McNEILL, OWLETT, MASSER,
ISAACSON, QUINN, WILLIAMS, NEILSON, WENTLING, TOOHIL, WARREN,
GABLER, T. DAVIS, SOLOMON AND HARKINS, APRIL 29, 2019
AS AMENDED ON THIRD CONSIDERATION, IN SENATE, JUNE 29, 2020
AN ACT
Providing for consumer prescription drug pricing disclosure and
pharmacy freedom to communicate.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Consumer
Prescription Drug Pricing and Freedom Disclosure Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Contract." A contract administered by a pharmacy benefits
manager PHARMACY BENEFIT MANAGER or pharmacy services
administration organization.
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"Covered entity." A contract holder or policy holder
providing pharmacy benefits to a covered individual under a
health insurance policy pursuant to a contract administered by a
pharmacy benefits manager PHARMACY BENEFIT MANAGER.
"Covered individual." A member, participant, enrollee or
beneficiary of a covered entity who is provided health coverage
by the covered entity. The term includes a dependent or other
person provided health coverage through the policy or contract
of a covered individual.
"Health insurance policy." A policy, subscriber contract,
certificate or plan that provides prescription drug coverage.
The term includes both comprehensive and limited benefit health
policies.
"Pharmacist." As defined in section 2(10) of the act of
September 27, 1961 (P.L.1700, No.699), known as the Pharmacy
Act.
"Pharmacy." As defined in section 2(12) of the Pharmacy Act.
"Pharmacy benefits management." "PHARMACY BENEFIT
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) Retail pharmacy network management.
(iv) Paying claims to pharmacies for prescription
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drugs dispensed to covered individuals by a retail,
specialty 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." "PHARMACY BENEFIT MANAGER." A
person, business or other entity that performs pharmacy benefits
management PHARMACY BENEFIT MANAGEMENT FOR COVERED ENTITIES. THE
TERM DOES NOT INCLUDE AN ENTITY THAT HOLDS A VALID LICENSE BY
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 INSURANCE COMPANY LAW OF 1921, INCLUDING SECTION 630 AND
ARTICLE XXIV OF THAT ACT.
(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." A person,
business or other entity that performs any of the following:
(1) Negotiates and contracts with managed care
organizations or pharmacy benefit managers on behalf of their
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pharmacy members.
(2) Negotiates reimbursement rates, payment and audit
terms on behalf of their pharmacy members.
(3) Payment collection or reconciliation on behalf of
their pharmacy members. PROVIDES PAYMENT COLLECTION OR
RECONCILIATION SERVICES ON BEHALF OF THEIR PHARMACY MEMBERS.
Section 3. Disclosure of prescription drug costs.
(a) Information to covered individual.--A pharmacy or
pharmacist shall have the right to provide a covered individual
with information concerning the cost of a prescription drug,
including the individual's cost share.
(b) No prohibition or penalization.--A pharmacy, pharmacist
or contracting agent of a pharmacy or pharmacist may not be
prohibited from or penalized by a pharmacy benefits manager
PHARMACY BENEFIT MANAGER or pharmacy services administration
organization for discussing the information under subsection
(a), disclosing the availability of therapeutically equivalent
alternative medications or selling to the covered individual a
more affordable alternative if an affordable alternative is
available.
Section 4. Disclosure of contract information.
(a) Disclosure authorized.--A pharmacy benefits manager or
pharmacy services administration organization shall not
prohibit, restrict or limit written or oral disclosure of
contract information by a pharmacist or pharmacy to any State,
county or municipal official or before any State, county or
municipal committee, body or proceeding.
(b) Penalty prohibited.--A pharmacy benefits manager or
pharmacy services administration organization shall not penalize
or restrict a pharmacist or pharmacy for any disclosure under
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subsection (a).
Section 5 4. Effective date.
This act shall take effect immediately.
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