PRINTER'S NO. 3270
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2029
Session of
2015
INTRODUCED BY GAINEY, YOUNGBLOOD, THOMAS, SCHWEYER, D. COSTA,
BULLOCK, MURT, PASHINSKI, MILLARD, KINSEY, MAHONEY, ROZZI,
COHEN, KIM, FRANKEL, READSHAW, DRISCOLL, STURLA, GERGELY,
M. DALEY, MCCLINTON, D. MILLER AND DAVIDSON, MAY 2, 2016
REFERRED TO COMMITTEE ON HEALTH, MAY 2, 2016
AN ACT
Establishing the Prescription Drug Program within the Department
of Human Services.
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 Prescription
Drug Program 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:
"Department." The Department of Human Services of the
Commonwealth.
"Pharmacy benefit manager." A prescription drug claims
processor that:
(1) Negotiates and executes contracts with pharmacies.
(2) Negotiates rebates with prescription drug
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manufacturers.
(3) Serves as an intermediary between the program and
prescription drug manufacturers and pharmacies.
"Prescription drug claims processor." An entity that:
(1) Processes and pays prescription drug claims.
(2) Adjudicates pharmacy claims.
(3) Transmits prescription drug prices and claims data
between pharmacies and the program.
(4) Processes related payments to pharmacies.
"Program." The Prescription Drug Program established under
section 3.
Section 3. Prescription Drug Program.
(a) Establishment.--There is established the Prescription
Drug Program within the department.
(b) Purposes.--The purposes of the program shall be to:
(1) Purchase prescription drugs or reimburse pharmacies
for prescription drugs in order to receive discounted prices
and rebates.
(2) Make prescription drugs available at the lowest
possible cost to participants in the program.
(3) Maximize the purchasing power of prescription drug
consumers in this Commonwealth in order to negotiate the
lowest possible prices for the consumers.
Section 4. Powers and duties of department.
(a) Administration of program generally.--The program shall
be administered by the department, which shall:
(1) Negotiate price discounts and rebates on
prescription drugs with prescription drug manufacturers.
(2) Purchase prescription drugs on behalf of
participants in the program.
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(3) Determine program prices and reimburse pharmacies
for prescription drugs.
(4) Develop a system for allocating and distributing the
operational costs of the program and any rebates obtained to
participants of the program.
(5) Cooperate with other states or regional consortia in
the bulk purchase of prescription drugs.
(6) Establish terms and conditions for pharmacies to
enroll in the program.
(b) Contracts.--Subject to the provisions of 62 Pa.C.S.
(relating to procurement), the department may enter into
contracts with prescription drug claims processors or pharmacy
benefit managers.
(c) Application process.--
(1) The department shall cause to be made available and
distributed an application for enrollment in the program.
(2) The department may charge a participant a nominal
fee to:
(i) Process the application for enrollment in the
program.
(ii) Produce and distribute identification cards for
the program.
Section 5. Program prices.
(a) Calculation and transmittal to pharmacy.--The program
shall calculate and transmit the program prices for prescription
drugs to an enrolled pharmacy.
(b) Charges to program participant.--The pharmacy shall
charge a participant the program price for a pharmaceutical if
the participant presents a valid program identification card.
Section 6. Enrollment.
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(a) General rule.--Subject to subsection (b),
notwithstanding any special or general law to the contrary, the
department shall automatically enroll all consumers receiving
pharmaceuticals through another department or an agency or
entity of the Commonwealth into the program.
(b) Exception.--If another department or an agency or entity
of the Commonwealth can empirically demonstrate to the
department that program enrollment would result in a net
increase in costs either to the Commonwealth or the consumers,
the other department, agency or entity shall be exempt from
automatic enrollment in the program.
Section 7. Federal waiver.
If a Federal waiver is necessary for the participation of the
consumer in the program, the department shall take all necessary
steps to obtain the waiver, and any other department, agency or
entity of the Commonwealth that provided pharmaceuticals to the
consumer shall cooperate with the department in obtaining the
waiver.
Section 8. Regulations.
The department shall promulgate regulations necessary to
implement and administer the provisions of this act. The
regulations shall address, but not be limited to:
(1) The enrollment of pharmacies in the program.
(2) The issuance of prescription drug identification
cards to participants in the program.
Section 9. Reports.
(a) Transmittal to General Assembly.--Beginning one year
after enactment and annually thereafter, the department shall
submit a report on the progress of program implementation to:
(1) The chairperson and minority chairperson of the
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Public Health and Welfare Committee of the Senate.
(2) The chairperson and minority chairperson of the
Finance Committee of the Senate.
(3) The chairperson and minority chairperson of the
Health Committee of the House of Representatives.
(4) The chairperson and minority chairperson of the
Human Services Committee of the House of Representatives.
(5) The chairperson and minority chairperson of the
Finance Committee of the House of Representatives.
(b) Contents.--Each report under this section shall include,
but not be limited to:
(1) The number of existing participants and anticipated
participants in the program.
(2) The number of participants for whom the program has
purchased and expects to purchase prescription drugs.
(3) The total and average individual savings of
prescription drug prices for participants as well as
projected total and average individual savings of
prescription drug prices for participants.
(4) Progress toward expanding the program.
(5) Any recommendations for legislation that the
department feels is needed to further implement and expand
program participation.
Section 10. Effective date.
This act shall take effect in 180 days.
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