PRINTER'S NO. 1328
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1042
Session of
2015
INTRODUCED BY DeLUCA, PICKETT, THOMAS, HARKINS, McNEILL AND
D. COSTA, APRIL 21, 2015
REFERRED TO COMMITTEE ON INSURANCE, APRIL 21, 2015
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for pharmaceutical cost transparency.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.7. Pharmaceutical Cost Transparency.--(a) With
respect to a prescription drug with an average wholesale price
of five thousand dollars ($5,000) or more annually or per course
of treatment, a health insurance policy or government program
providing benefits for prescriptions shall not be required to
provide the benefits if the manufacturer of the prescription
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drug has not filed a report on the drug as required under
subsection (b).
(b) On or before March 1 of each year, a manufacturer of a
prescription drug covered under subsection (a) shall file with
the Insurance Department the following information on a form
prescribed by the Insurance Department:
(1) The costs for the production of the drug, including the
following:
(i) The research and development costs paid by the
manufacturer, and separately, the research and development costs
paid by any predecessor in the development of the drug.
(ii) The costs of clinical trials and other regulatory costs
paid by the manufacturer, and separately, the costs of clinical
trials and other regulatory costs paid by any predecessor in the
development of the drug.
(iii) The costs for materials, manufacturing and
administration attributable to the drug.
(iv) The costs paid by any entity other than the
manufacturer or predecessor for research and development,
including, but not limited to, any amount from Federal, State or
other governmental programs or any form of subsidies, grants or
other support.
(v) The other costs to acquire the drug, including costs for
the purchase of patents, licensing or acquisition of a corporate
entity owning rights to the drug while in development, or all of
the costs under this subparagraph.
(vi) The marketing and advertising costs for the promotion
of the drug directly to consumers, including, but not limited
to:
(A) Costs associated with coupons or discounts, that are
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directed to consumers and the amount redeemed.
(B) Marketing and advertising costs for promotion of the
drug directly or indirectly to prescribers.
(C) Any other advertising for the drug.
(2) The filing under paragraph (1) must be audited and
certified by an independent third-party auditor prior to filing.
(3) A cumulative annual history of average wholesale price
increases for the drug expressed as percentages, including the
months each average wholesale price increase took effect.
(4) The profit attributable to the drug as represented in
dollars and represented as a percentage of the total company
profits that were derived from the sale of the drug.
(5) A description of the manufacturers' patient prescription
assistance programs, including, but not limited to:
(i) The amount of financial assistance provided.
(ii) The amount of financial assistance provided to
residents of this Commonwealth.
(iii) The average amount of assistance per resident of this
Commonwealth and for which drugs the assistance was provided.
(iv) The parameters and qualifications for the patient
prescription assistance programs.
(6) Any payments, direct or indirect, to hospitals, health
care providers and physicians in excess of the actual
acquisition costs of the prescription drugs covered under
subsection (a).
(c) As used in this section:
(1) "Government program" means any of the following:
(i) The Commonwealth's medical assistance program
established under the act of June 13, 1967 (P.L.31, No.21),
known as the Public Welfare Code.
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(ii) The Children's Health Care Program established under
Article XXIII.
(iii) The program of pharmaceutical assistance for the
elderly established under Chapter 5 of the act of August 26,
1971 (P.L.351, No.91), known as the State Lottery Law.
(2) "Health insurance policy" means a group or individual
health or sickness or accident insurance policy, subscriber
contract or certificate issued by an entity subject to any one
of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the Health Maintenance Organization Act.
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
The term does not include accident only, fixed indemnity,
limited benefit, credit, dental, vision, specified disease,
Medicare supplement, Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement, long-term care or
disability income, workers' compensation or automobile medical
payment insurance.
(3) "Insurer" means an entity that issues a group or
individual health, sickness or accident policy or subscriber
contract described under paragraph (2).
(4) "Prescription" means a written or oral order issued by a
duly licensed medical practitioner in the course of the
practitioner's professional practice for a controlled substance,
other drug or device or medication that is dispensed for use by
a consumer.
Section 2. This act shall take effect in 60 days.
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