H0947B2372A09300 AJM:JSL 06/29/16 #90 A09300
AMENDMENTS TO HOUSE BILL NO. 947
Sponsor: REPRESENTATIVE FABRIZIO
Printer's No. 2372
Amend Bill, page 2, line 8, by striking out "Department of
Health of the Commonwealth" and inserting
Insurance Department of the Commonwealth
Amend Bill, page 2, lines 12 through 14, by striking out all
of said lines
Amend Bill, page 2, by inserting between lines 19 and 20
"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 4, line 11, by inserting a period after
"department"
Amend Bill, page 4, lines 11 through 30; page 5, lines 1
through 20; by striking out "annually by:" in line 11, all of
lines 12 through 30 on page 4 and all of lines 1 through 20 on
page 5 and inserting
The department shall promulgate regulations to implement
this section.
Amend Bill, page 5, line 21, by striking out "Maximum
allowable cost" and inserting
Multiple source generic
Amend Bill, page 5, lines 22 through 30; page 6, lines 1
through 10; by striking out "Before a PBM places a drug on a
maximum" in line 22, all of lines 23 through 30 on page 5 and
all of lines 1 through 10 on page 6 and inserting
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In order to place a particular drug on a multiple source
generic list, a PBM shall, at a minimum, ensure that:
(1) the drug is listed as "A," "B," "NR" or "NA" rated
in the most recent version of the Food and Drug
Administration's "Approved Drug Products with Therapeutic
Equivalence Evaluations," commonly known as the orange book;
and
(2) the drug is available for purchase by all pharmacies
in this State from national or regional wholesalers and is
not obsolete or temporarily unavailable.
(b) Removal from listing.--A PBM must maintain a procedure
to eliminate drugs from the list of drugs subject to multiple
source drug pricing or modify the maximum allowable cost in a
timely fashion.
(c) Substitutions.--A PBM may not penalize a pharmacist or
pharmacy on audit if the pharmacist or pharmacy performs a
generic substitution pursuant to the act of November 24, 1976
(P.L.1163, No.259), referred to as the Generic Equivalent Drug
Law.
Amend Bill, page 6, line 11, by striking out "maximum
allowable cost" and inserting
multiple source generic
Amend Bill, page 6, line 12, by inserting before "Upon"
(a) General rule.--
Amend Bill, page 6, lines 12 and 13, by striking out "make
available"
Amend Bill, page 6, lines 15 through 30; pages 7 and 8, lines
1 through 30; by striking out all of said lines on said pages
Amend Bill, page 9, lines 1 through 8, by striking out all of
said lines and inserting
representative or agent such as PSAO:
(1) Include in the contract the sources utilized to
determine multiple source drug pricing, including, if
applicable, the maximum allowable cost or any successive
pricing formula of the PBM.
(2) Update the pricing information every seven calendar
days.
(3) Establish a reasonable process by which pharmacies
have a method to access relevant or current maximum allowable
cost pricing lists in effect and any successive pricing
formulas in a timely fashion.
(b) Confidentiality provision.--Nothing in this section may
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prohibit a PBM from establishing a reasonable confidentiality
provision with a pharmacy's or pharmacist's contracting
representative agent such as a PSAO.
Section 6. Multiple source generic drug pricing appeals
process.
(a) Process to be established.--All contracts between a PBM
or a pharmacy, or alternatively, a pharmacy's contracting agent,
such a PSAO, shall include a process to appeal, investigate and
resolve disputes regarding multiple source drug pricing. The
contract provision establishing the process shall include the
following:
(1) The right to appeal shall be limited to 14 calendar
days following the initial claim.
(2) The appeal shall be investigated and resolved by the
PBM through an internal process within 14 calendar days of
receipt of the appeal by the PBM.
(3) A telephone number at which a pharmacy may contact
the PBM and speak with an individual who is involved in the
appeals process.
(b) Denial.--If a PBM denies an appeal, the PBM shall
provide the reason for the denial and identify the national drug
code of an equivalent drug that is available for purchase by
network retail pharmacies in this Commonwealth from wholesalers
at a price that is equal to or less than the maximum allowable
cost for the appealed drug as determined by the PBM.
(c) Approval.--If a PBM grants an appeal, the PBM shall make
the price correction, permit the reporting pharmacy to reverse
and rebill the appealed claim and make the price correction
effective for all similarly situated pharmacies from the date of
the approved appeal.
Amend Bill, page 9, line 9, by striking out "8" and inserting
7
Amend Bill, page 9, line 10, by striking out "(a) Action by
the department.--"
Amend Bill, page 9, lines 14 through 23, by striking out all
of said lines
Amend Bill, page 9, line 24, by striking out "9" and
inserting
8
Amend Bill, page 9, by inserting between lines 26 and 27
Section 9. Applicability.
This act shall apply to all contracts and agreements for
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pharmacy benefits management services executed or renewed on or
after the effective date of this section.
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