PRIOR PRINTER'S NO. 1314

PRINTER'S NO. 1677

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

1000

Session of

2024

INTRODUCED BY J. WARD, TARTAGLIONE, KEARNEY, DUSH, HUTCHINSON,

BREWSTER, COLEMAN, MASTRIANO, CULVER, PENNYCUICK, LAUGHLIN,

FLYNN, STEFANO, ARGALL, AUMENT, BARTOLOTTA, A. WILLIAMS,

Amending the act of November 21, 2016 (P.L.1318, No.169),

entitled "An act providing for pharmacy audit procedures, for

registration of pharmacy benefits managers and auditing

entities, for maximum allowable cost transparency and for

prescription drugs reimbursed under the PACE and PACENET

program; and making related repeals," further providing for

title of act; in preliminary provisions, further providing

for short title and for definitions; in pharmacy audits,

further providing for limitations; and providing for pharmacy

Integrity and Transparency Act, are amended to read:

SECTION 1. THE TITLE OF THE ACT OF NOVEMBER 21, 2016

(P.L.1318, NO.169), KNOWN AS THE PHARMACY AUDIT INTEGRITY AND

TRANSPARENCY ACT, IS AMENDED TO READ:

Providing for pharmacy audit procedures, for registration of

This act shall be known and may be cited as the [Pharmacy

Audit Integrity and Transparency] Community Pharmacy Protection

Act.

Section 2. Section 103 of the act is amended by adding

definitions to read:

Section 103. 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:

* * *

discount rate for all prescriptions filled by a member pharmacy

during the term of the contract.

* * *

"Generic effective rate." The reimbursement rate paid to the

pharmacy based on a percentage of the average wholesale cost for

generic drugs dispensed by the pharmacy under the contract with

the pharmacy benefit manager.

pharmacies approved by the PBM PHARMACY BENEFIT MANAGER .

(2) The use of co-pay differentials between PBM-

affiliated pharmacies and nonaffiliated pharmacies. FOR

PHARMACIES CONTRACTED WITH THE PHARMACY BENEFIT MANAGER AND

PHARMACIES THAT ARE NOT CONTRACTED WITH THE PHARMACY BENEFIT

MANAGER.

* * *

"Spread pricing." An act of A PRACTICE USED BY a pharmacy

benefit manager reimbursing TO REIMBURSE a pharmacy for a

prescription and then billing BILL an insurer or an employer

(c) Scrivener error.--A scrivener error made by a pharmacy

not attributed to fraud, waste or abuse that is discovered

during an audit of the pharmacy by the PBM PHARMACY BENEFIT

MANAGER shall result in the PBM PHARMACY BENEFIT MANAGER

recouping the dispensing fee for that particular transaction,

not the entire amount of the medication DRUG received by the

patient.

Section 4. The act is amended by adding a chapter to read:

(1) Require participation in the PBM's network

contingent on the pharmacy signing either an effective rate

contract or a contract based on the National Average Drug

Acquisition Cost guidelines.

(2) Include provisions allowing for retroactive

recoupment of money paid to a pharmacy by the PBM, unless

both parties agree to that provision.

(3) Base reimbursement upon general effective rate or

the brand effective rate as a condition of entering a

network, unless both parties agree to that provision. Any

brand effective rates or direct and indirect remuneration

fees made by the PBM.

Section 602. Spread pricing participation prohibited.

A pharmacy benefit manager may not conduct or participate in

spread pricing.

Section 603. Patient steering prohibited.

A pharmacy benefit manager may not conduct or participate in

patient steering.

(3) Develop a Statewide National Average Drug

Acquisition Cost guideline that uses wholesale pricing based

on manufacturer's invoices of those manufacturers who ship

drugs to this Commonwealth.

Section 605. Duties of pharmacy benefit managers.

Pharmacy benefit managers shall:

(1) Approve a request from a pharmacy to be a member of

the PBM's network within 30 days of the initial request to

join the network.

(2) Provide a dedicated telephone number and email

maximum prevailing fee for service or PACE rate in this

Commonwealth.

Section 607. Reports by PBM.

A PBM shall report to the department the amount of rebates

and payments received from drug manufacturers and how the

rebates and payments were distributed by the PBM.

CHAPTER 6

PHARMACY BENEFIT MANAGER CONTRACT

THAN THE NATIONAL AVERAGE DRUG ACQUISITION COST AS

REIMBURSEMENT FOR PURCHASING A DRUG.

(2) REQUIRE RETROACTIVE RECOUPMENT OF MONEY PAID TO A

PHARMACY BY THE PHARMACY BENEFIT MANAGER.

(3) INCLUDE ADDITIONAL FEES UNLESS DISCLOSED AND APPLIED

AT THE TIME OF THE ADJUDICATION OF THE CLAIM, INCLUDING, BUT

NOT LIMITED TO:

(I) TRANSACTION FEES.

(II) CHARGEBACKS DUE TO RECALCULATION OF THE COST OF

THE INGREDIENTS USED IN A PRESCRIPTION DRUG.

PLUS A DISPENSING FEE AS IS OTHERWISE REQUIRED BY A PHARMACY

CONTRACT.

SECTION 602. SPREAD PRICING.

A PHARMACY BENEFIT MANAGER MAY NOT CONDUCT OR PARTICIPATE IN

SPREAD PRICING.

SECTION 603. PATIENT STEERING.

A PHARMACY BENEFIT MANAGER MAY NOT CONDUCT OR PARTICIPATE IN

PATIENT STEERING, INCLUDING REQUIRING THAT PATIENTS OR ANY OR

RESOLVING COMPLAINTS A PHARMACY FILES AGAINST A PHARMACY

BENEFIT MANAGER.

(2) ESTABLISH LICENSURE REQUIREMENTS AND REGULATE

PHARMACY BENEFIT MANAGERS, NOTWITHSTANDING OWNERSHIP OR

AFFILIATION WITH ANY OTHER ENTITY ALREADY LICENSED BY THIS

COMMONWEALTH, OPERATING OR EXERCISING CONTRACTS IN THIS

COMMONWEALTH.

(3) ESTABLISH A REIMBURSEMENT RATE NO LESS THAN THE

MEDICARE DISPENSING FEE ESTABLISHED BY THE CENTERS FOR

MEDICARE AND MEDICAID SERVICES TO BE REIMBURSED TO PHARMACIES

(1) REVIEW REQUESTS FROM A PHARMACY TO JOIN THE NETWORK

OF THE PHARMACY BENEFIT MANAGERS AND APPROVE OR DENY THE

REQUESTS IN WRITING WITHIN 30 DAYS OF THE DATE OF EACH

REQUEST. IF A PHARMACY'S REQUEST IS DENIED, THE PHARMACY

BENEFIT MANAGER MUST PROVIDE ITS REASONING FOR THE DENIAL

WITHIN THE CORRESPONDENCE ISSUED TO THE PHARMACY.

(2) PROVIDE A DEDICATED TELEPHONE NUMBER AND EMAIL

ADDRESS FOR HANDLING NETWORK REQUESTS AND CUSTOMER SERVICE

OF HOW THE REBATES AND PAYMENTS WERE DISTRIBUTED BY THE PHARMACY

BENEFIT MANAGER. IF AUDITS REQUIRED UNDER SECTION 604(4)

DETERMINE THAT A PHARMACY WAS REIMBURSED LESS THAN THE COST OF

ACQUIRING AND DISPENSING A DRUG, THE DEPARTMENT SHALL HAVE THE

AUTHORITY TO REQUIRE THE PHARMACY BENEFIT MANAGER TO RECOUP THE

LOSS FROM THE MANUFACTURER REBATES RECEIVED AND REQUIRE THAT THE

AMOUNT OF THE LOSS BE PAID TO THE PHARMACY WITHIN 30 DAYS OF THE

AUDIT SUBMISSION.

SECTION 5. THIS ACT APPLIES TO CONTRACTS ENTERED INTO OR

RENEWED ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION.

Section 5 6. This act shall take effect in 60 days.