PRINTER'S NO. 782
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
639
Session of
2019
INTRODUCED BY PHILLIPS-HILL, BLAKE, LEACH, VOGEL, FOLMER,
J. WARD, SCHWANK, AUMENT, HUTCHINSON, KILLION, BREWSTER AND
K. WARD, MAY 13, 2019
REFERRED TO BANKING AND INSURANCE, MAY 13, 2019
AN ACT
Providing for consumer prescription drug pricing disclosure, for
pharmacy freedom to communicate and for enforcement by the
Insurance Department.
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 and Freedom 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:
"Contract." A contract administered by a pharmacy benefits
manager.
"Covered entity." A contract holder or policy holder
providing pharmacy benefits to a covered individual under a
health insurance policy pursuant to a contract administered by a
pharmacy benefits manager.
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"Covered individual." A member, participant, enrollee 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 or contract
of a covered individual.
"Department." The Insurance Department of the Commonwealth.
"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.
"Pharmacist." As defined in section 2(10) of 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) 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.
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(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
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.
"Pharmacy services administration organization." A company
that provides contract negotiation, communication and help-desk
services between pharmacies and pharmacy benefits managers.
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 information concerning the cost of a prescription drug,
including the individual's cost share.
(b) No prohibition or penalization.--A pharmacy, pharmacist
or contracting agent of a pharmacy or pharmacist may not be
prohibited from or penalized by a pharmacy benefits manager for
discussing the information under subsection (a), disclosing the
availability of therapeutically equivalent alternative
medications or selling to the covered individual a more
affordable alternative if an affordable alternative is
available.
Section 4. Disclosure of contract information.
(a) Disclosure authorized.--A pharmacy benefits manager
shall not prohibit, restrict or limit written or oral disclosure
of contract information by a pharmacist or pharmacy to any
State, county or municipal official or before any State, county
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or municipal committee, body or proceeding, or the media,
including, but not limited to, social media platforms.
(b) Penalty prohibited.--A pharmacy benefits manager shall
not penalize or restrict a pharmacist or pharmacy for any
disclosure under subsection (a).
(c) Removal of pharmacy from network prohibited.--A pharmacy
benefits manager shall not require, request or imply by contract
or other means, that a pharmacy services administration
organization or any other subcontractor, remove a pharmacy from
the network or penalize the pharmacy for any disclosure under
subsection (a).
Section 5. Enforcement.
The department shall enforce the provisions of this act and
shall impose an administrative fine of not less than $10,000 for
a violation of this act.
Section 6. Effective date.
This act shall take effect in 60 days.
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