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A07374
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2211
Session of
2018
INTRODUCED BY WARD, CORBIN, BOBACK, MILLARD, ORTITAY, ROTHMAN,
JAMES, PICKETT, McGINNIS, RAPP, READSHAW, OBERLANDER,
PASHINSKI, FLYNN, B. MILLER, MENTZER, TOEPEL, IRVIN, SCHLEGEL
CULVER, CRUZ, HEFFLEY, J. McNEILL, GROVE, HILL-EVANS, SAYLOR,
COX, WATSON, JOZWIAK, FARRY, PHILLIPS-HILL, FEE, LONGIETTI,
CHARLTON, BARRAR, GILLEN, PEIFER, KAUFFMAN, KLUNK, MATZIE,
KORTZ, HELM, MEHAFFIE AND O'NEILL, MAY 29, 2018
REFERRED TO COMMITTEE ON HEALTH, MAY 29, 2018
AN ACT
Providing for consumer prescription drug pricing disclosure.
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 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:
"Covered entity." A member, participant, enrollee,
contractholder or policyholder providing pharmacy benefits to a
covered individual under a health coverage plan pursuant to a
contract administered by a pharmacy benefit manager.
"Covered individual." A member, participant, enrollee,
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contractholder or policyholder 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, contract or plan of a covered
individual.
"Pharmacist." As defined in section 2(10) 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." 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
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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 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 all available information concerning the cost of a
prescription drug, including, but not limited to, the
individual's cost share.
(b) No prohibition or penalization.--Neither a pharmacy, a
pharmacist nor its contracting agent shall be prohibited from or
penalized by a pharmacy benefits manager for discussing the
information under subsection (a), disclosing the availability of
any therapeutically equivalent alternative medications or
selling to the covered individual a more affordable alternative
if an affordable alternative is available.
Section 4. Effective date.
This act shall take effect in 60 days.
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