Amendment 10845 to House Bill 946 P.N. 3933, Regular Session 2015-2016

H0946B3933A10845 AJM:EJH 10/24/16 #90 A10845

AMENDMENTS TO HOUSE BILL NO. 946

Sponsor: SENATOR WHITE

Printer's No. 3933

Amend Bill, page 1, line 3, by inserting after "MANAGERS"

and auditing entities

Amend Bill, page 10, lines 9 and 10, by striking out "A

HEALTH PROGRAM ADMINISTERED BY A DEPARTMENT OF THE COMMONWEALTH

OR ANY" and inserting

or an

Amend Bill, page 10, lines 10 and 11, by striking out

"COMPANY, GROUP OR DEPARTMENT" and inserting

covered entity

Amend Bill, page 10, line 16, by striking out the comma after

"PERSON" and inserting

Amend Bill, page 10, line 16, by striking out "OR GOVERNMENT

ENTITY"

Amend Bill, page 10, line 17, by striking out "PLAN SPONSOR"

and inserting

covered entity

Amend Bill, page 10, line 22, by striking out "MEMBER,

PARTICIPANT, ENROLLEE,"

Amend Bill, page 10, line 24, by striking out "COVERAGE PLAN"

and inserting

insurance policy

Amend Bill, page 10, line 27, by striking out "CONTRACT

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HOLDER OR POLICYHOLDER"

Amend Bill, page 10, line 30, by striking out ", CONTRACT OR

PLAN" and inserting

or contract

Amend Bill, page 11, lines 9 through 11, by striking out all

of said lines

Amend Bill, page 11, by inserting between lines 14 and 15

"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.

"Health insurer." An entity licensed by the department with

authority to issue a policy, subscriber contract, certificate or

plan that provides prescription drug coverage that is offered or

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 thereof.

(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).

Amend Bill, page 11, by inserting between lines 22 and 23

"Multiple source generic list." A list of drugs, medical

products or devices, or both, for which a maximum allowable cost

has been established by a pharmacy benefits manager.

Amend Bill, page 12, line 13, by striking out "BENEFICIARIES

OF A HEALTH BENEFIT PLAN" and inserting

a covered individual

Amend Bill, page 12, line 14, by striking out "ANY ENTITY

THAT PERFORMS" and inserting

The performance of

Amend Bill, page 12, lines 22 and 23, by striking out

"PROVISION OF ANY OF THE FOLLOWING IN CONJUNCTION WITH THE"

Amend Bill, page 12, line 23, by inserting after "benefits"

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, including

Amend Bill, page 12, line 24, by striking out "MAIL-SERVICE"

and inserting

Operating a mail-service

Amend Bill, page 12, line 26, by striking out "RETAIL" and

inserting

Managing a retail pharmacy

Amend Bill, page 12, line 26, by striking out "MANAGEMENT"

Amend Bill, page 12, line 27, by striking out "PAYMENT OF"

and inserting

Paying

Amend Bill, page 12, line 27, by striking out "PHARMACIES"

and inserting

a pharmacy

Amend Bill, page 12, line 30, by striking out "CLINICAL" and

inserting

Developing and managing a clinical

Amend Bill, page 12, line 30; page 13, line 1; by striking

out "DEVELOPMENT AND MANAGEMENT" in line 30 on page 12 and

"SERVICES" in line 1 on page 13

Amend Bill, page 13, line 1, by striking out ", BUT NOT

LIMITED TO,"

Amend Bill, page 13, line 4, by striking out "CERTAIN" and

inserting

Managing a

Amend Bill, page 13, line 5, by striking out "PROGRAMS" and

inserting

program

Amend Bill, page 13, line 6, by striking out "DISEASE" and

inserting

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Operating a disease

Amend Bill, page 13, line 6, by striking out "PROGRAMS" and

inserting

program

Amend Bill, page 13, line 19, by striking out "PHARMACIES"

and inserting

a pharmacy

Amend Bill, page 13, line 20, by striking out "CAN" and

inserting

that may

Amend Bill, page 13, lines 21 and 22, by striking out ". THE

ADMINISTRATIVE SERVICES VARY BUT MAY INCLUDE" and inserting

, including

Amend Bill, page 13, lines 24 through 30; page 14, lines 1

through 13; by striking out all of said lines on said pages

Amend Bill, page 14, line 22, by striking out "AN" and

inserting

that

Amend Bill, page 14, line 23, by striking out "ANY

INFORMATION" and inserting

Information

Amend Bill, page 14, line 26, by striking out "PLAN SPONSOR"

and inserting

covered entity

Amend Bill, page 14, line 28, by striking out "NO" and

inserting

The

Amend Bill, page 14, line 28, by striking out "SHALL" and

inserting

may not

Amend Bill, page 14, line 29, by striking out "ANY OF ITS

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EMPLOYEES" and inserting

an employee

Amend Bill, page 14, line 29, by striking out "ANY" where it

occurs the second time

Amend Bill, page 15, line 1, by inserting after "AUDIT,"

solely

Amend Bill, page 15, line 3, by inserting after "THE"

auditing

Amend Bill, page 15, lines 9 and 10, by striking out all of

line 9 and "(6)" in line 10 and inserting

(5)

Amend Bill, page 15, line 10, by inserting after "THE"

auditing

Amend Bill, page 15, line 12, by striking out "ANY" and

inserting

Amend Bill, page 15, line 14, by striking out "(7)" and

inserting

(6)

Amend Bill, page 15, line 14, by inserting after "THE"

auditing

Amend Bill, page 15, line 18, by striking out "(8)" and

inserting

(7)

Amend Bill, page 15, line 18, by inserting after "THE"

auditing

Amend Bill, page 15, line 22, by striking out "(9) ANY" and

inserting

(8) A

Amend Bill, page 15, line 24, by striking out "(10) NO" and

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inserting

(9) A

Amend Bill, page 15, line 24, by striking out "SHALL" and

inserting

may not

Amend Bill, page 15, line 27, by striking out "PLAN SPONSOR"

and inserting

covered entity

Amend Bill, page 15, line 30, by striking out "SHALL" and

inserting

does

Amend Bill, page 16, line 2, by striking out "(11) NO" and

inserting

(10) The

Amend Bill, page 16, line 2, by inserting after "MAY"

not

Amend Bill, page 16, line 6, by striking out "(12) NO" and

inserting

(11) The

Amend Bill, page 16, line 6, by striking out "SHALL" and

inserting

may not

Amend Bill, page 16, line 13, by striking out "(13)" and

inserting

(12)

Amend Bill, page 17, line 7, by striking out "THE" and

inserting

Amend Bill, page 17, line 8, by inserting after "60"

calendar

Amend Bill, page 17, line 19, by inserting after "30"

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calendar

Amend Bill, page 17, line 29, by striking out "PHARMACY"

Amend Bill, page 18, line 1, by striking out "NO" and

inserting

Amend Bill, page 18, line 1, by striking out "SHALL" and

inserting

may not

Amend Bill, page 18, line 6, by striking out "NO" and

inserting

Amend Bill, page 18, line 7, by striking out "SHALL" and

inserting

may not

Amend Bill, page 18, line 24, by striking out "SHALL" and

inserting

Amend Bill, page 18, line 25, by inserting after "AN"

investigative

Amend Bill, page 19, line 4, by striking out "ENFORCEMENT"

and inserting

Regulations

Amend Bill, page 19, lines 5 through 8, by striking out

"SHALL HAVE ENFORCEMENT AUTHORITY AND TAKE" in line 5, all of

lines 6 and 7 and "ANY" in line 8 and inserting

may promulgate

Amend Bill, page 19, line 8, by inserting after "REGULATIONS"

Amend Bill, page 19, line 8, by inserting after "NECESSARY"

and appropriate

Amend Bill, page 19, line 10, by striking out all of said

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line and inserting

REGISTRATION

Amend Bill, page 19, line 11, by inserting after "PBM"

and auditing entity

Amend Bill, page 19, line 12, by inserting before "TO"

(a) General rule.--

Amend Bill, page 19, line 12, by inserting after "PBM"

or auditing entity

Amend Bill, page 19, lines 13 and 14, by striking out

"PROMULGATE REGULATIONS" in line 13 and all of line 14 and

inserting

make an application form available on its publicly

accessible Internet website that shall require:

(1) The identity, address and telephone number of the

applicant.

(2) The name, business address and telephone number of

the contact person for the applicant.

(3) When applicable, the Federal employer identification

number for the applicant.

(b) Term and fee.--

(1) The term of registration shall be two years from the

date of issuance.

(2) The department shall set an initial application fee

and a renewal application fee, which shall be submitted with

an application for registration. An initial application fee

shall be nonrefundable. A renewal application fee shall be

returned if the renewal of the registration is not granted.

(3) The amount of the initial application fee and

renewal application fee shall be sufficient to fund the

department's duties in relation to its responsibilities under

this chapter, but may not exceed $1,000.

(1) The department shall issue a registration, as

appropriate, to an applicant when the department determines

that the applicant has submitted a completed application and

paid the required registration fee.

(2) The registration may be in paper or electronic form,

shall be nontransferable and shall prominently list the

expiration date of the registration.

(d) Duplicate registration.--

(1) A licensed insurer or a manged care plan with a

certificate of authority shall comply with the standards and

procedures of this act but shall not be required to

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separately register as either a PBM or auditing entity.

(2) A PBM that is registered under this chapter shall

comply with the standards and procedures of this act but

shall not be required to register separately as an auditing

entity.

CHAPTER 7

PBM COST TRANSPARENCY

REQUIREMENTS

Amend Bill, page 19, line 15, by striking out "502" and

inserting

701

Amend Bill, page 19, line 15, by striking out "GENERIC DRUG"

and inserting

Multiple source generic

Amend Bill, page 19, line 17, by striking out "GENERIC DRUG"

and inserting

multiple source generic

Amend Bill, page 19, line 18, by striking out ""A," "B," "NR"

OR "NA"" and inserting

"A" or "B"

Amend Bill, page 19, lines 21 and 22, by striking out the

semicolon in line 21 and all of line 22 and inserting

, or "NR" or "NA" rated, or similar rating, by a

nationally recognized reference;

(2) There are at least two therapeutically equivalent

multiple source drugs or at least one generic drug available

from only one manufacturer; and

Amend Bill, page 19, line 23, by striking out "(2)" and

inserting

(3)

Amend Bill, page 19, line 24, by striking out "STATE" and

inserting

Commonwealth

Amend Bill, page 20, line 5, by striking out "503" and

inserting

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702

Amend Bill, page 20, line 5, by striking out "GENERIC DRUG"

and inserting

multiple source generic

Amend Bill, page 20, lines 8 and 9, by striking out

"ALTERNATIVELY, A PBM AND A PHARMACY'S CONTRACTING

REPRESENTATIVE OR AGENT SUCH AS" and inserting

its representative, including

Amend Bill, page 20, line 22, by striking out "PHARMACY'S OR

PHARMACIST'S CONTRACTING" and inserting

pharmacy or its

Amend Bill, page 20, line 23, by striking out "AGENT SUCH AS"

and inserting

, including

Amend Bill, page 20, line 24, by striking out "504" and

inserting

703

Amend Bill, page 21, line 20, by striking out "505.

ENFORCEMENT." and inserting

704. Regulations.

Amend Bill, page 21, lines 21 through 24, by striking out all

of said lines

Amend Bill, page 21, line 25, by striking out "SHALL" and

inserting

may

Amend Bill, page 21, line 25, by inserting after

"REGULATIONS"

Amend Bill, page 21, line 25, by inserting after "NECESSARY"

and appropriate

Amend Bill, page 21, line 27, by striking out "507" and

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inserting

705

Amend Bill, page 21, by inserting after line 30

CHAPTER 9

ENFORCEMENTS

Section 901. Scope of enforcement authority.

(a) Scope.--The department may investigate and enforce the

provisions of this act only insofar as the actions or inactions

being investigated relate to prescription drug coverage under a

health insurance policy.

(b) Remedy.--Actions or inactions within the scope of the

department's investigative and enforcement authority under

subsection (a) found to violate this act constitute "unfair

methods of competition" and "unfair or deceptive acts or

practices" within the meaning of section 5 of the act of July

22, 1974 (P.L.589, No.205), known as the Unfair Insurance

Practices Act. A proceeding under this section shall be

conducted in accordance with 2 Pa.C.S. Ch. 5 Subch. A (relating

to practice and procedure of Commonwealth agencies).

Amend Bill, page 22, line 5, by striking out "THE ADDITION OF

CHAPTER" and inserting

Chapters

Amend Bill, page 22, line 5, by inserting after "5"

, 9 and 11

Amend Bill, page 22, line 7, by striking out "60" and

inserting

180

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