SB 2 (Pharmacy Benefit Manager)
Approved: March 20, 2018 Sponsor: Sen. Ronald Caldwell
Description: Prohibits a pharmacy benefit manager from prohibiting a pharmacy or pharmacist from disclosing information regarding the total cost for pharmacist services for a prescription drug or from selling a more affordable alternative to an individual. Establishes pharmacy benefit licensure and reporting requirements.
HB 2107 (Pharmacy Benefit Manager)
Approved: April 5, 2018 Sponsor: Rep. Maria Syms
Description: Prohibits a pharmacy benefit manager or other entity that administers prescription drug benefits from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of a lower cost including the cash price.
HB 1284 (Pharmacy Benefit Manager)
Approved: April 30, 2018 Sponsor: Rep. Buckner
Description: Prohibits a pharmacy benefit manager or carrier from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of an alternative prescription drug and lower cost including the cash price. Prohibits pharmacy benefit managers from charging or collecting a copayment that exceeds the total charges submitted by the network pharmacy.
HB 5384 (Transparency)
Approved: May 31, 2018 Sponsor: House of Representatives Insurance and Real Estate Committee
Description: Impose additional disclosure and reporting requirements on pharmacy benefit managers, health carriers, pharmaceutical manufacturers, the Office of Health Strategy and the Insurance Department concerning prescription drug rebates and the cost of prescription drugs. Requires pharmacy benefit manager disclosures to include health plan client’s formularies, including and changes and exclusions. Requires health carriers to disclose to the Insurance Commissioner if any drug has increased in price more than 25 percent. Requires the insurance commissioner to post this information on the department’s website. Requires manufacturers to disclose net drug cost after rebates and to inform the Office of Health Strategy when it has submitted a drug approval application to the US Food and Drug Administration. Would also require manufacturer to disclose price increase justifications to Office of Health Strategy, who in turn is reuired to post this information on its website. Requires the Office of Health Strategy to annually list 10 drugs whose wholesale acquisition cost has increased by 25 percent and that represents substantial state spending.
HB 351 (Pharmacy Benefit Manager)
Approved: March 27, 2018 Sponsor: Rep. David Santiago
Description: Requires pharmacists to inform customers of certain generically equivalent drug products and whether cost-sharing obligations to such customers exceed retail price of prescription. Requires pharmacy benefit managers to register with the Office of Insurance Regulation. Requires pharmacy benefit managers to create a process to allow pharmacy appeals of pharmacy benefit manager reimbursements.
HB 339 (Drug Substitution)
Approved: March 7, 2018 Sponsor: House of Delegates Health and Welfare Committee
Description: Permits a licensed prescriber to authorize a pharmacist to substitute a drug with another drug in the same therapeutic class that would have a substantially-equivalent therapeutic effect even though the substitute drug is not a therapeutic equivalent drug.
HB 1317 (Pharmacy Benefit Manager)
Approved: March 25, 2018 Sponsor: Rep. Edward Clere
Description: Permits a pharmacy or pharmacist to provide individuals with information concerning the individual’s cost share for a prescription drug. Would prohibit a third party administrator, health insurer or a health maintenance organization from limiting the ability of a pharmacy or pharmacist to discuss information about, or from selling to the individual, a more affordable alternative. Would prohibit a copayment for a drug under the state employee health plan, an accident and sickness insurance policy, or a health maintenance organization from exceeding the amount payable to the pharmacy for the drug. Requires Board of Pharmacy to adopt rules concerning telepharmacy.
SB 351 (Pharmacy Benefit Manager)
Approved: March 29, 2018 Sponsor: Senate Public Health and Welfare Committee
Description: Prohibits a pharmacy benefits manager from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of a lower cost including the cash price. Prohibits pharmacy benefit managers from reducing reimbursement after a claim has been adjudicated or charge or hold a pharmacist or pharmacy responsible for any fee that is related to a claim. Prohibits a pharmacy benefit manager from requiring a covered person to use prescription mail service pharmacy. Prohibits a pharmacy benefit manager from restricting a covered person’s ability to access prescription medications available at network pharmacies.
SB 5 (Pharmacy Benefit Manager)
Approved: April 13, 2018 Sponsor: Sen. George Wise
Description: Requires the Department for Medicaid services to directly administer all outpatient pharmacy benefits and prohibit pharmacy benefits in Medicaid managed care contracts.
HB 463 (Pharmacy Benefit Manager)
Approved: April 10, 2018 Sponsor: Rep. Micheal Meredith
Description: Prohibits a pharmacy benefit manager from requiring that an insured person pay greater than the cash price for a prescription drug. Prohibits a pharmacy benefit manager from prohibiting a pharmacy or pharmacist from providing an insured person information regarding applicable limitations on his or her cost sharing for a prescription drug.
SB 283 (Pharmacy Benefit Manager)
Approved: May 23, 2018 Sponsor: Sen. Fred Mills
Description: Requires pharmacy benefit managers to be licensed by the Louisiana Department of Insurance, which would post licensure information on its website. Requires pharmacy benefit managers to issue an annual transparency report that discloses aggregate data on rebates received from drug manufacturers, administrative fees, and aggregate rebates received that did not pass through to the health benefit plan or insurer. Permits enforcement against pharmacy benefit managers license for failure to comply.
HB 436 (Pharmacy Benefit Manager)
Approved: May 31, 2018 Sponsor: Rep. Robert Johnson
Description: Would prohibit pharmacy benefit manager pharmacy network contract provisions that prohibit pharmacist from disclosing any relevant information to a consumer, including but not limited to the cost of the prescription medication, actual reimbursement of the drug to the pharmacist, efficacy of the prescription medication, and the availability of any alternative medications that are less expensive than the prescription medication. Would require pharmacy benefit managers to disclose data sources for reimbursement decisions and have a reimbursement appeals process.
SB 130 (Pharmacy Benefit Manager)
Approved: May 25, 2018 | Sponsor: Sen. Fred Mills
Description: Requires Medicaid pharmacy benefit manager contracts to be limited to a set per transaction rate for every pharmacy claim paid. Prohibits all pharmacy benefit managers from retaining federal drug rebates or “spread pricing” amounts in excess of what they paid the pharmacist.
LD 1406 (Transparency)
Approved: May 1, 2018 Sponsor: Sen. Eloise Vitelli, Sen. Michael Carpenter, Rep. Robert Foley
Description: Directs the Maine Health Data Organization to report on the 25 most commonly prescribed drugs that have experienced large cost hikes. The organization must establish a plan for data collection from manufacturers, and provide Maine lawmakers with an annual report on prescription drug prices beginning in April 2019.
SB 576 and HB 736 (Pharmacy Benefit Manager)
Approved: April 24, 2018 Sponsor: Sen. Katherine Klausmeier
Description: Would prohibit a pharmacy benefit manager from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of an alternative prescription drug and lower cost including the cash price.
HB 1349 (Pharmacy Benefit Manager)
Approved: May 8, 2018 Sponsor: Del. Carl Anderton
Description: Requires pharmacy benefit managers to register with the Maryland Insurance Commissioner. Prohibits a pharmacy benefit manager from prohibiting a pharmacy or pharmacist from providing a beneficiary with information regarding a retail price or cost share for a prescription drug. Prohibits a pharmacy benefit manager from retaliating against a contracted pharmacy for filing a complaint. Requires that a pharmacy benefit manager be transparent in contracts about pharmacy payment methodology and pricing sources that generate pharmacy reimbursements. Pricing sources would be updated every seven days. Pharmacy benefit managers would have to have an appeals process for pharmacies.
HB 709 (Pharmacy Benefit Managers)
Approved: March 8, 2018 Sponsor: Rep. Sam Mims
Description: Prohibits a pharmacy benefit manager from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of a lower cost treatment or payment option including the cash price.
SB 826 (Pharmacy Benefit Manager, Drug Substitution)
Approved: May 30, 2018 Sponsor: Sen. David Sater
Description: Modifies provisions relating to health care records, limitations on prescribing opioids, disposal of unused controlled substances, the Advisory Council on Rare Diseases and Personalized Medicine, long-acting reversible contraceptives, newborn eye drops, vaccine protocols, maintenance medicine, and prescription eye drops. Allows a pharmacist who receives a prescription for a brand-name drug or biological product to select a less expensive, generically-equivalent drug or interchangeable biological product unless requested otherwise by a patient or prescribing doctor who indicates no substitution. Limits the patient’s drug out-of-pocket cost to the lesser of: the insurance benefit cost sharing and the price that would be charged in the absence of any insurance coverage (the cash price). Would permit a pharmacy or pharmacist to provide patients with information about the cost share for a prescription drug, cost of an alternative drug, and cost of drug without adjudicating claim through a pharmacy benefit manager.
HB 1746 (Pharmacy Benefit Manager)
Approved: May 31, 2018 Sponsor: Rep. Erin Hennessey
Description: Would prohibit a pharmacy benefit manager from requiring accreditation, credentialing, or licensing of providers other than by the New Hampshire Pharmacy Board or other state or federal entity.
SB 481 (Study: Pharmacy Benefit Manager)
Approved: June 4, 2018 Sponsor: Sen. Donna Soucy
Description: Establishes a committee to study the impact of pharmacy benefit manager operations on costs, administration, and distribution of prescription drugs.
HB 1791 (Pharmacy Benefit Manager)
Approved: June 11, 2018 Sponsor: Rep. Edward Butler
Description: Would prohibit insurers and pharmacy benefit managers from penalizing a pharmacy or pharmacist for disclosing to the consumer information about the cost of the prescription and availability of therapeutically-equivalent alternative medication or alternative methods of purchasing the prescription. Would limit insured consumers’ drug out-of-pocket to the lesser of: the insurance benefit cost sharing, the amount the insurer or pharmacy benefit manager will reimburse the pharmacy for the dispensed drug, or the price that would be charged in the absence of any insurance coverage (the cash price).
HB 4005 (Transparency)
Approved: March 26, 2018 Sponsor: Rep. Robert Nosse
Description: Requires prescription drug manufacturer to report annually information to the Department of Consumer and Business Services regarding prices of prescription drugs and costs associated with developing and marketing prescription drugs. Authorizes the department to impose civil penalties on manufacturers for failing to comply with reporting requirements. Requires health insurers that offer prescription drug benefits to report to department specified information about prescription drug prices and impact of prescription drug prices on premium rates. Authorizes the department to impose fees on manufacturers. Requires the department to conduct an annual public hearing on prescription drug prices and related information reported by manufacturers. Establishes a task force on the Fair Pricing of Prescription Drugs.
H 5038 (Pharmacy Benefit Manager)
Approved: May 14, 2018 Sponsor: Rep. Todd Atwater
Description: Prohibits a pharmacy benefit manager from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of a lower cost including the cash price. Would prohibit pharmacy benefit managers from reducing reimbursement after a claim has been adjudicated or charging or holding a pharmacist or pharmacy responsible for any fee that is related to a claim. Would prohibit a pharmacy benefit manager from restricting pharmacy delivery services. Would prohibit a pharmacy benefit manager from restricting a covered person’s ability to access prescription medications available at network pharmacies.
SB 141 (Pharmacy Benefit Manager)
Approved: February 27, 2018 Sponsor: Sen. Alan Solano
Description: Prohibits a pharmacy benefits manager from prohibiting or penalizing a pharmacist or pharmacy for providing cost sharing information on the amount a covered individual may pay for a particular prescription drug.
SB 75 (Substitution of Biologic Products)
Approved: February 8, 2018 Sponsor: Sen. Deb Soholt
Description: Permits a pharmacist dispensing a prescription drug order for a biological product prescribed by its brand or proper name to select an interchangeable biological product of the prescribed product. Would prohibit pharmacist from dispensing an equivalent or interchangeable biological drug product if a brand name has been prescribed unless patient is informed of selection and given right of refusal. Would permit prescriber to prohibit a pharmacist from selecting an equivalent drug product or interchangeable biological product by handwriting on the prescription drug order “brand necessary.”
HB 1857 and SB 1852 (Pharmacy Benefit Manager)
Approved: May 4, 2018| Sponsor: Rep. Dennis Powers
Description: Would require a pharmacy benefit manager to obtain a license through the Department of Commerce and Insurance. Would impose a fine on pharmacy benefit managers for failure to obtain a license.
SB 208 (Pharmacy Benefit Manager)
Approved: March 19, 2018 Sponsor: Sen. Evan Vickers
Description: Requires a pharmacy benefit manager to report to pharmacies the amount of direct or indirect remuneration related to a sale, the reason for direct/indirect remuneration, if the direct/indirect remuneration is a reduction in total compensation, and what the pharmacy can do to prevent direct/indirect remuneration in the future. It would also prohibit a pharmacy benefit manager from preventing a pharmacist from disclosing cost information to a patient.
S 175 (Importation from Canada)
Approved: May 16, 2018 Sponsor: Sen. Tim Ashe
Description: Establishes a wholesale importation program to import predetermined, high-cost drugs from Canada. Would create a bulk-purchasing program through the Department of Health. Would require that manufacturers submit notice before introducing new, high-cost drugs to the market. Would require health insurers to provide information on the impact of prescription drug spending on premium rates as part of their annual rate review.
Approved: May 30, 2018| Sponsor: Senator Virginia Lyons
Description: Requires pharmacists to dispense the lowest-priced, generic or interchangeable product. Require an insurer to annually file a summary of proposed rates, including an analysis of the impact of drug cost on premium increases. Separately, requires insurers of different sizes to report on a specified number of most frequently prescribed drugs by average wholesale price for each drug, by the total spend, and by higher year on year price increases. Requires a subset of manufacturers to provide cost justification to the attorney general, who will provide the report from the information received from manufacturers. The Green Mountain Care Board will post the report on its website. It also requires manufacturers to notify the attorney general of new drug launches priced at more than $670 and supply information about marketing and sales volume and other information to the attorney general. Would require pharmacy benefit manager transparency as well.
SB 933 (Pharmacy Benefit Manager)
Approved: March 30, 2018 Sponsor: Sen. Richard Saslaw
Description: Would prohibit a health carrier, pharmacy benefit manager, pharmacy, or pharmacist from charging an enrollee a drug copayment that is the lesser of applicable insurance copayment or the cash price without using enrollee’s health plan.
HB 1177 (Pharmacy Benefit Manager)
Approved: February 26, 2018 Sponsor: Del. Todd Pillian
Description: Would establish prohibited acts for pharmacy benefit managers. Would prohibit provider contracts from including provisions that bar pharmacists from discussing lower-cost alternative drugs with consumers and selling lower-cost alternative drugs to consumers or using contract terms to prevent pharmacies from providing store direct delivery services.
HB 520 (Drug Logistics)
Approved: March 2, 2018 Sponsor: Del. Keith Hodges
Description: Requires Board of Pharmacy registration for any warehouser, or third-party logistics provider located outside the state that ships prescription drugs or delivers into the state. Would allow the board to establish regulations relating to the storage, handling and distribution of prescription drugs and devices by any third-party logistics provider and warehousers. Would require non-resident, third-party logistics providers or warehousers to maintain a valid, unexpired license, permit, or registration in the state.
SB 46 (Pharmacy Benefit Manager)
Approved: April 23, 2018 Sponsor: Sen. Sue Cline
Description: Would permit pharmacists to inform customers about lower-cost alternatives to prescribed drugs. Would limit the ability of pharmacists and pharmacy benefit managers to charge retail prices for drugs in excess of the price paid for the drugs by pharmacists or pharmacy benefit managers.
HB 4524 (Substitution of Biologic Products)
Approved: April 17, 2018 Sponsor: Del. Joe Ellington
Description: Unless instructed otherwise by the purchaser, permits a pharmacist to select a less expensive, interchangeable biological product provided that the pharmacist provide notice to the patient about the selection. Permits prescribers to prohibit interchange by stating that the brand pharmaceutical or the specific biological product is medically necessary.
SF0075 (Substitution of Biologic Products)
Approved: March 16, 2018 Sponsor: Sen. Fred Baldwin
Description: Would permit a pharmacist to substitute an interchangeable biological for the prescribed original biologic product or substitute the generic equivalent of a prescribed pharmaceutical, unless the prescriber has clearly indicated that substitution is not permitted. Would require a pharmacist, upon dispensing an interchangeable biological product or generic-equivalent drug, to label the prescription container with the name of the dispensed biological product or drug.
AB 265 (Coupons)
Approved: October 10, 2017 | Sponsor: Asm Jim Wood
Description: This bill prohibits the distribution of manufacturer-sponsored drug coupons when other FDA-approved lower cost generic drugs are available, are covered under the individual’s health plan, and are not otherwise contraindicated for the condition for which the prescription drug is approved.
SB 17 (Drug Cost Transparency, PBM)
Approved: October 9, 2017 | Sponsor: Sen Ed Hernandez
Description: Requires manufacturers to notify all purchasers at least 90 days prior to the planned effective date of a price increase for prescription drugs currently on the market. Manufacturers would be required to provide information justifying these increases, as well as for when launch prices of new drugs that exceed the threshold set for a specialty drug under the Medicare Part D program. Requires all insurers to include in their yearly report specified drugs which make up the highest share of spending. Requires PBMs who receive a notice of an increase in WAC to notify their public and private purchasers of the increase.
The California Office of Statewide Health Planning and Development maintains a “Cost Transparency Rx” website with information on implementing SB 17 including information on upcoming activities, workshops, and FAQs.
PA 17-241 (Transparency, PBM)
Approved: October 1, 2017 | Sponsor: Committee on Public Health
Description: Prohibits future legislation preventing pharmacists from disclosing specified information to an individual purchasing a drug (i.e. the availability of any alternative less expensive medications). Prohibits health carrier or PBM from requiring an individual to pay for a covered prescription in an amount greater than the lesser of the (1) applicable copayment, (2) allowable claim amount (i.e. the amount the health carrier or PBM agreed to pay the pharmacy), or (3) amount an individual would pay for the drug if he or she had no insurance plan, benefits, or discounts. Authorizes the insurance commissioner to audit pharmacy services’ contracts for compliance and to enforce violations by voiding contracts that contain unfair trade practices.
HB 589 (Transparency)
Approved: June 9, 2017 | Sponsor: Rep Clay Yarborough
Description: Requires the Agency for Health Care Administration to collect data on the retail prices charged by pharmacies for the 300 most frequently prescribed drugs within the state; to be updated monthly. When a generic is available, the price data would be reported for both the generic and the equivalent brand name drug and made available on the agency’s internet website for each pharmacy to use.
HB 276 & SB 103 (PBM)
Approved: July 1, 2017 | Sponsor: Rep David Knight & Sen Jeff Mullis
Description: Authorizes the Commissioner of Insurance to promulgate rules and regulations to prohibit PBMs from requiring the use of mail-order pharmacies. Would ban the PBM practice that prohibits a pharmacist or pharmacy from providing an insured patient information regarding the amount of the patient’s prescription drug cost share and the clinical efficacy of a lower priced alternative drug if one is available. Neither pharmacy nor pharmacist shall be penalized for sharing information or for selling a more affordable alternative if one is available. Would prohibit PBMs charging or collecting from an insured a copayment that exceeds the total submitted charges by the network pharmacy for which the pharmacy is paid.
HB 1444 & SB 1158 (PBM)
Approved: June, 20, 2017 | Sponsor: Rep Dee Morikawa & Sen Rosalyn Baker
Description: Requires pharmacy benefit managers to register with the insurance commissioner. Any person who acts as a pharmacy benefit manager in this State without first being registered is subject to a fine of $500 for each violation.
HR 88 (Bulk Purchasing)
Approved: March 7, 2017 | Sponsor: Rep Mary Flowers
Description: Recognizes that the federal government has been able to use its purchasing power to reduce the price of prescription drugs through the VA system. Urges the federal government to monitor the ever-increasing costs of prescription drugs and to take any necessary action to reduce the out-of-pocket expenses for those purchasing medications.
HB 436 (Transparency)
Approved: August, 1, 2017 | Sponsor: Rep Kirk Talbot
Description: Requires each drug manufacturer or pharmaceutical marketer who engages in any form of prescription drug marketing to a prescriber, his or her designee, or any member of his or her staff in Louisiana to provide to the Louisiana Board of Pharmacy the current WAC information for each of the U.S. FDA approved drugs marketed in the state by that manufacturer.
HR 181 (Study)
Approved: June 8, 2017 | Sponsor: Rep Kirk Talbot
Description: Urges the Louisiana Department of Health to study the desirability and feasibility of adopting a state policy similar to the recently enacted policies of the states of New York, Texas, and Ohio to provide for the review of prescription drug prices and to encourage drug manufacturers to provide supplemental Medicaid rebates
SB 59 (Transparency)
Approved: June 14, 2017 | Sponsor: Sen Fred Mills
Description: Commits the Louisiana Board of Pharmacy to develop a website containing specified prescription drug pricing information to be made available to Louisiana prescribers.
S 2211 (Transparency)
Approved: November 9, 2017 | Sponsor: Senate Ways and Means Committee
Description: Amends the Health Care Cost Commission’s enabling statute to add, among other things, authority to conduct annual studies of pharmaceutical companies with pipeline, drugs, generic drugs, or biosimilars that may have a significant impact on statewide health expenditures.
SB 539 (Drug Cost Transparency)
Approved: June 15, 2017 | Sponsor: Sen Michael Roberson
Description: Require the Department of Health and Human Services to compile lists of prescription drugs that are used to treat diabetes, and require manufacturers and PBMs that sell these drugs to provide specified information to the Department which would keep proprietary information confidential. Requires manufacturers to submit a list of each sales Representative who markets prescription drugs in this State and further would prohibit any sales Representative who is not included on such a list from marketing drugs. Certain nonprofit organizations or patient assistance programs are required to report specified information concerning contributions and benefits received from drug manufacturers, insurers and PBMs or the trade and advocacy groups for such entities. Authorizes the Department to impose penalties for certain violations.
Nevada’s Department of Health and Human Services maintains a drug cost transparency website for implementing SB 539, including draft regulations, FAQs, and an implementation timeline.