Description: This measure prohibits pharmacy benefit managers (PBMs) from restricting pharmacies and pharmacists from disclosing cost information to patients about alternative drugs or other services and costs. This measure also requires PBMs to register with the state’s Department of Insurance.
Approved: April 11, 2019 Sponsor: Rep. Nancy Barto
Description: This measure requires that when calculating an insured individual’s contribution to any applicable cost-sharing requirement, an insurer or pharmacy benefit manager (PBM) must include any cost-sharing amount paid by either the enrollee or another person on behalf of the enrollee for a drug that is without a generic equivalent.
Description: This measure allows pharmacists to make biological product substitutions only when there will be cost savings for the patient. The pharmacist must disclose the amount of the savings at the request of the patient.
Description: This measure requires a pharmacy benefit manager (PBM) to report rebate information to the Arkansas Insurance Commissioner on a quarterly basis. This bill also prohibits a PBM from conducting “spread pricing” in the state. Under this bill, spread pricing applies to prescription drug pricing in which the PBM charges a plan a contracted price for prescription drugs, and the contracted price for the drugs differs from the amount the PBM directly or indirectly pays the pharmacist.
This measure also requires a PBM to provide an appeal procedure to allow pharmacies to challenge maximum allowable drug cost lists and reimbursements made under a maximum allowable cost list if pharmacies are paid less for a drug than the current approved fee for the fee-for-service Arkansas Medicaid program-covered outpatient prescription drug reimbursement that includes an ingredient cost for the drug.
Approved: May 16, 2019 Sponsor: Rep. Sonya Jacquez-Lewis
Description: This measure requires a drug manufacturer or a representative of a manufacturer to provide the wholesale acquisition cost of a prescription drug to an entity or individual with whom the manufacturer or wholesale is sharing information about the drug.
Approved: May 14, 2019 Sponsor: Rep. Dylan Roberts
Description: This measure caps the cost sharing a covered person is required to pay for prescription insulin drugs to $100 per one-month supply of insulin. The bill requires the Department of Law to investigate the pricing of prescription insulin drugs and submit a report of its finding.
Approved: May 16, 2019 Sponsor: Rep. Robert Rodriguez
Description: This measure directs the Department of Health Care Policy and Financing to design a program to allow for the wholesale importation of prescription pharmaceutical products from Canada for sale to Colorado consumers.
Adopted: April 18, 2019 Sponsor: Rep. Raymond Seigfried
Description: This measure establishes the Interagency Pharmaceuticals Purchasing Study Group to review and made recommendations on how to leverage the bulk purchasing power of the state to negotiate lower prices.
Adopted: June 19, 2019 Sponsor: Rep. Andria Bennett
Description: This measure prohibits insurers and pharmacy benefit managers from engaging in the practice of clawbacks. Under this measure, a carrier may not impose a copayment or coinsurance requirement for a covered drug that exceeds the lesser of the applicable cost-sharing amount or the amount an individual would pay for the drug if the individual were paying the usual and customary price.
Adopted: June 27, 2019 Sponsor: Rep. Andria Bennett
Description: This measure establishes a task force to study pharmacy reimbursement practices in the state and the best practices and laws of other states to develop recommendations for action by the General Assembly or others. The task force must focus on reimbursement practices of pharmacy benefit managers.
Adopted: July 17, 2019 Sponsor: Rep. Andria Bennett
Description: This measure requires pharmacy benefit managers (PBMs) to register with the Insurance Commissioner and empowers the commissioner to issue cease-and-desist orders based on fraudulent acts or violations committed by PBMs. Under this bill, a PBM engaging in maximum allowable cost (MAC) pricing must make available to each network provider the sources utilized to determine the MAC pricing, provide a way for providers to readily access the most recently-updated MAC list, review and update MAC information at least once every week, and ensure that dispensing fees are not included in MAC calculations.
Description:This measure establishes a wholesale drug importation from Canada program. The state will contract with a vendor to provide services under the program, and the vendor will develop a wholesale prescription drug importation list identifying the prescription drugs that have the highest potential for savings to the state.
Approved: April 10, 2019 Sponsor: Rep. Robin Shackleford
Description: This measure urges the legislative council to assign to the Interim Study Committee on Public Health, Behavioral Health, and Human Services the task of studying issues related to prescription drug price transparency by drug manufacturers in Indiana.
Approved: May 6, 2019 Sponsor: Rep. Martin Carbaugh
Description: This measure urges the legislative council to assign to an appropriate interim study committee the topic of regulating pharmacy benefit managers (PBMs) and their practices. If the topic is studied, the committee must provide any recommendations concerning licensure of PBMs and contracts that limit the disclosure of pricing information to consumers and other practices.
Approved: June 6, 2019 Sponsor: Rep. Bernard LeBas
Description:This measure authorizes a pharmacist to decline to dispense a prescription drug covered by an insurance plan if the coverage provider reimburses the pharmacy in an amount less than the drug’s acquisition cost. If a pharmacy declines to provide a drug, the pharmacy must provide the consumer with information as to where the prescription may be filled.
Description:This measure requires a pharmacy benefit manager (PBM) to obtain licensure from the state and authorizes the State Board of Medical Examiners to regulate PBMs. This measure additionally prohibits PBMs from participating in spread pricing practices — which allows PBMs to charge insurance plans more for a prescription than it charges the dispensing pharmacy — in most circumstances. This measure also prohibits a PBM from reimbursing a local pharmacy less than a chain pharmacy. Additionally, this measure creates the PBM Monitoring Advisory Council. This measure requires PBMs to use good faith, honesty, trust, confidence and candor to PBM plan beneficiaries.
Description:This measure allows the Louisiana Department of Health to remove pharmacy services from Medicaid managed care organization contracts and assume direct responsibility for all Medicaid pharmacy services. If the department does not carve out pharmacy services from Medicaid contracts, the pharmacy benefit manager administering benefits must be reimbursed a transaction fee only and will not be allowed to retain any portion of spread pricing or state supplemental rebates.
Adopted: June 24, 2019 Sponsor: Sen. Eloise Vitelli
Description: This measure requires manufacturers to report annually to the Maine Health Data Organization (MHDO) about drug prices when manufacturers have, during the prior calendar year, increased the wholesale acquisition cost (WAC) of a brand-name drug by more than 20 percent per pricing unit, increased the WAC of a generic that costs at least $10 per pricing unit by more than 20 percent per pricing unit, or introduced a new drug for distribution when the WAC is greater than the Medicare Part D threshold. The bill also requires manufacturers, wholesale drug distributors, and pharmacy benefit managers to provide pricing component data per pricing unit of a drug within 60 days of a request by the MHDO.
Description: This measure establishes a Canadian wholesale prescription drug importation program. Maine’s Department of Health and Human Services must submit a request for approval and certification of the program to the US Department of Health and Human Services no later than May 1, 2020. This bill allows Maine to consider whether the program may be developed on a multistate basis through collaboration with other states.
Description: This bill establishes the Maine Prescription Drug Affordability Review Board. The board is made up of five members and has a 12-member advisory council. The board may recommend that a public payer pay an annual assessment to support the administrative costs of the board. Beginning in 2021, the board will determine annual spending targets for prescription drugs purchased by public payers based on a 10-year rolling average of the medical care services component of the Consumer Price Index plus a reasonable percentage for inflation and minus a spending target determined by the board for pharmacy savings. The board will also have the authority to determine spending targets on specific drugs that may cause affordability challenges to enrollees in a public plan. The board will determine methods for a public payer to meet spending targets established by the board and must determine if the following methods would reduce costs to individuals purchasing drugs through a public payer:
• Negotiating specific rebate amounts on drugs that contribute most to spending that exceeds the targets;
• Changing a formulary when sufficient rebates cannot be secured;
• Changing a formulary with respect to all of the prescription drugs of a manufacturer within a formulary when sufficient rebates cannot be secured;
• Establishing a common formulary for all public payers;
• Prohibiting health insurance carriers from offering on their formularies a drug by a manufacturer when methods to change a formulary are implemented;
• Bulk purchasing through a single purchasing agreement;
• Collaborating with other states and consortia to purchase in bulk or to jointly negotiate rebates;
• Allowing insurance carriers providing coverage to small businesses and individuals to participate in the public payer prescription drug benefit for a fee; and
• Procuring common expert services for public payers, including PBM services.
The board must report its recommendations, including spending targets, by Oct. 1, 2020. View the bill here.
LD 1504 (Pharmacy Benefit Manager)
Adopted: June 24, 2019 Sponsor: Sen. Heather Sanborn
Description: This measure ensures that a pharmacy benefits manager (PBM) has a fiduciary duty to a carrier client. This measure prohibits PBMs from penalizing pharmacies or pharmacists for disclosing cost information to consumers. This bill also prohibits a carrier or PBM from requiring a consumer to make an excessive payment at the point of sale for a covered prescription drug. Under this bill, any compensation remitted by a manufacturer and retained by the PBM must be used by the carrier to lower premium costs or remitted directly to the covered person at the point of sale to reduce out-of-pocket costs. Additionally, if a carrier uses any PBM to administer or manage drug benefits, this bill provides that any PBM compensation constitutes an administrative cost incurred by a carrier for purposes of calculating anticipated loss ratio.
Approved: May 25, 2019 Sponsor: Del. Joseline Peña-Melnyk
Description: This measure establishes a Prescription Drug Affordability Board, which will be required to study the entire pharmaceutical distribution and payment system, as well as policy options used by other states and countries to lower the list price of pharmaceuticals, including setting upper payment limits, using a reverse auction marketplace, and implementing a bulk purchasing process. This study must be conducted before Dec. 31, 2020.
Under this bill, the board must identify circumstances under which the cost of a prescription drug product may create or has created affordability challenges. If the board finds that it is in the best interest of the state to establish a process for setting upper payment limits for drugs that cause affordability challenges, the board must draft a plan of action for implementing the process that includes the criteria the board will use to set the upper payment limits. The plan must either be approved by the Legislative Policy Committee or the Governor and Attorney General.
The board will use information collected from the pharmaceutical supply chain to identify brand-name drugs that have a launch wholesale acquisition cost (WAC) of $30,000 or more per year, or that have had a WAC increase of $3,000 or more in a year. The board will also identify biosimilar drugs that have a launch WAC that is not priced more than 15 percent lower than the referenced brand biologic. For generics, the board will identify drugs that have a WAC of $100 or more for a course of treatment or that increased by 200 percent or more during the immediately preceding 12-month period.
Description: This is the conference committee version of the governor’s budget proposal. Under this bill, the Executive Office of Health and Human services may directly negotiate supplemental rebate agreements (SRAs) with manufacturers for drugs covered by MassHealth. Negotiations may be based on value, efficacy, or outcomes of a drug. Before seeking an SRA with a manufacturer, the executive office must consider a drug’s actual cost to the state and whether the manufacturer is providing significant discounts relative to other drugs covered by MassHealth.
If the executive office and the manufacturer cannot conclude negotiations for an SRA and the drug is projected to exceed a cost of $25,000 per person per year or an aggregate annual cost to MassHealth of $10 million, the executive office may identify a proposed value of the drug. The executive office must consider a variety of factors when determining the proposed SRA or proposed value. There will be a public hearing in which the manufacturer can provide testimony. After the hearing, the executive office can make any updates to the proposed value or can engage in additional negotiations with the manufacturer. If, after this process, the manufacturer and executive office are unable to conclude negotiations, the Secretary of Health and Human Services will refer the manufacturer to the Health Policy Commission for review.
The Health Policy Commission can then require a manufacturer of a specific drug to disclose drug pricing information, including a schedule of the drug’s wholesale acquisition cost (WAC) over the past five years. Based on the information submitted, the commission may identify a proposed supplemental rebate for that drug. The proposed supplemental rebate may be based on a proposed value of the drug. If, after review of any records furnished, the commission determines that the manufacturer’s pricing of the drug is potentially unreasonable or excessive in relation to the commission’s proposed value, the commission must request the manufacturer provide additional drug pricing information and the manufacturer’s justification for that pricing. This measure requires the commission to base its determination solely on the analysis or research of an outside third party. Each year, the executive office will report on the amount of supplemental rebates received under this law, the number of drugs receiving a supplemental rebate under this law, and a breakdown of the duration of the supplemental rebates received.
Unlike previous versions of this bill, this version does not require manufacturers to negotiate or attend public hearings, and companies accused of charging excessive prices will not be referred to the attorney general.
Approved: May 30, 2019 Sponsor: Sen. Michelle Benson
Description:This measure is the omnibus health and human services appropriation bill. Under this bill, a health plan that imposes a cost-sharing requirement on the coverage of a prescription insulin drug must limit the total amount of cost-sharing that an enrollee is required to pay at the point of sale, including deductible payments and the cost-sharing amounts charged once the deductible is met, at an amount that does not exceed the net price of the prescription insulin drug.
Description:This measure requires a pharmacy benefit manager (PBM) to obtain a license. This measure also requires PBMs to disclose rebate and pricing information to plan sponsors and the state’s Commissioner of Commerce. Under this bill, PBMs would be required to provide pharmacies with a maximum allowable cost (MAC) list, which must be updated every seven business days. PBMs must also provide the sources used to determine the MAC pricing. This measure also prohibits a PBM from prohibiting a pharmacist from disclosing information about the cost of the drug or the availability of alternative therapies. This bill imposes cost-sharing limits for consumers at the point of sale and allows a pharmacist to substitute a therapeutically equivalent and interchangeable drug in place of a prescribed drug. Under this bill, a PBM cannot retroactively adjust a claim for reimbursement submitted by a pharmacy.
Description: This measure allows pharmacists to make a product selection for an interchangeable biological product in the same manner as a generic drug only when the selection will result in lower costs to the purchaser.
Description: This measure prohibits a pharmacy benefit manager (PBM) from penalizing a pharmacy or pharmacist for disclosing reimbursement criteria to an enrollee or for selling a more affordable alternative to a person covered by insurance. This bill also prohibits a PBM from requiring a pharmacy to charge or collect a copayment from an enrollee that exceeds the total charges submitted by the network pharmacy.
Approved: April 24, 2019 Sponsor: Sen. Mark Kolterman
Description: This bill prohibits a pharmacy benefit manager (PBM) from collecting from a person covered by insurance a copayment for a prescription that exceeds the lesser of the individual’s applicable cost sharing or the amount retained by the network pharmacy for filling the prescription. This measure also prohibits a PBM from penalizing a pharmacy or pharmacist for sharing cost information with a consumer.
Approved: June 5, 2019 Sponsor: Asm. Cresent Hardy
Description:This bill prevents a pharmacy benefit manager from prohibiting a pharmacist or pharmacy from providing information to a consumer concerning the availability of a less expensive or more effective drug or a less expensive manner of acquiring a drug. This bill also prohibits a pharmacy benefit manager from penalizing a pharmacist or pharmacy for selling a less expensive generic drug or a more effective drug to such a person.
Description:This bill directs the Legislative Commission to appoint a committee to conduct an interim study into the issue of the costs of prescription drugs, including the impact of rebates, reductions in price, and other remuneration from drug manufacturers affecting prescription drug prices.
Adopted: June 14, 2019 Sponsor: Rep. Yvanna Cancela
Description: This measure requires any contract between Nevada’s Department of Health and Human Services and a pharmacy benefit manager or health maintenance organization (HMO) to provide information about services provided to the organization. This bill also requires any HMOs that enter into a contract with the department to provide all rebates received through the purchase of drugs to the department, except for an administrative fee. If the department does not enter into such a contract, the bill requires the department to directly manage and coordinate pharmacy benefit services. This measure also requires the Children’s Health Insurance Program to use the list of preferred drugs used in the Medicaid program.
Description: This measure creates the Commission to Study the Impact of Financial Initiatives for Commercially Insured Members by Drug Manufacturers on Prescription Drug Prices and Health Insurance Premiums. The commission must submit a report to the Legislature by Nov. 1, 2019.
Approved: March 28, 2019 Sponsor: Sen. Jeff Steinborn
Description: This measure establishes the Interagency Pharmaceuticals Purchasing Council and instructs it to:
Review and coordinate cost-containment strategies for the procurement of pharmaceuticals and pharmacy benefits and the pooling of risk for pharmacy services by the constituent agencies;
Identify ways to leverage constituent agencies’ pharmaceutical and pharmacy benefits procurement to maximize the purchasing power of New Mexico residents who purchase pharmaceuticals or pharmacy benefits in the private sector; and
Identify other cost-saving opportunities for New Mexico residents purchasing pharmaceuticals or pharmacy benefits in the private sector.
Approved: April 4, 2019 Sponsor: Sen. Bill O’Neill
Description: This measure requires a pharmacy benefit manager (PBM) to reimburse a pharmacy or pharmacist in an amount equal to or greater than the amount that the PBM reimburses an affiliate for providing the same prescription. This measure also prohibits a PBM from prohibiting a pharmacist from providing cost information to a patient or from selling a more affordable alternative medication.
Adopted: July 18, 2019 Sponsor: Sen. Scott Oelslager
Description: This is included in the budget. Under this measure, if the Department of Medicaid includes prescribed drugs in the care management system, the Medicaid director will select a third-party administrator to serve as the single pharmacy benefit manager (PBM) used by Medicaid managed care organizations under the care system. The Medicaid director will determine the rate the state PBM is paid for its services. The state PBM will provide a quarterly transparency report to the director.
This measure also prohibits a health plan issuer, PBM or any other administrator to require cost-sharing in an amount greater than the lesser of the amount an individual would pay for the drug if the drug was purchased without coverage under a health benefit plan or the net reimbursement paid to the pharmacy for the prescription drug by the health plan issuer, PBM, or administrator.
This bill also creates the Prescription Drug Transparency and Affordability Advisory Council within the Department of Administrative Services. The council must submit a report to the governor and General Assembly within six months of appointment. The report must include recommendations addressing: 1) how the state can best achieve drug price transparency; 2) new payment models or other avenues to create the most affordable environment for purchasing prescription drugs; 3) leveraging the state’s purchasing power across all state agencies, boards, commissions and similar entities; 4) creating efficiencies across different health care systems; 5) which critical outcomes can be measured and used to improve the state’s system of purchasing affordable prescribed drugs; and 6) how federal, state and local resources are being used to optimize these outcomes and identify where the resources can be better coordinated or redirected to meet the needs of consumers.
Description: This measure minimizes pharmacy benefit manager (PBM) conflicts of interest by prohibiting higher reimbursement rates for PBM-owned pharmacies. This measure also prohibits retroactive claims adjustment and denials. Under this bill, a PBM cannot engage in false advertising or limit a pharmacy from disclosing cost information to enrollees.
Adopted: June 20, 2019 Sponsor: Rep. Andrea Salinas
Description: This measure requires drug manufacturers to report any planned increase in the price of certain prescription drugs at least 60 days before the date of the increase. Advance notices of price increases will be required for a brand-name prescription drug for which there was a cumulative increase of 10 percent or more or an increase of $10,000 or more during the past 12 months. Notifications will be required for a generic drug for which there was a cumulative increase of 25 percent or more and an increase of $300 or more in the past 12 months.
Approved: May 16, 2019 Sponsor: Sen. Michael Gambrell
Description: This measure establishes a licensure requirement for pharmacy benefit managers (PBM). This measure prohibits a PBM from prohibiting or penalizing a pharmacy or pharmacist for informing a patient about therapies or risks. This measure authorizes a pharmacist to provide information to the insured about the total cost for pharmacist services for a prescription drug.
Approved: March 7, 2019 Sponsor: Rep. Spencer Gosch
Description: This measure stipulates that no pharmacy benefit manager (PBM) may require a health plan or pharmacist to collect from an insured individual a cost-share for a prescription that exceeds the amount retained by the pharmacist from all payment sources. This bill also prohibits a PBM from retroactively adjusting claim payments for the benefit of a covered individual if there was an error in the adjudication of a claim submitted on behalf of the enrollee.
Approved: May 29, 2019 Sponsor: Rep. Cameron Sexton
Description:This measure prohibits a pharmacy benefit manager (PBM) from reimbursing a pharmacy or pharmacist for a drug in an amount less than the covered entity or PBM reimburses itself of an affiliate for providing the same drug.
Adopted: June 14, 2019 Sponsor: Rep. Tom Oliverson
Description: This measure requires annual reports from pharmaceutical manufacturers that contain the wholesale acquisition cost (WAC) information for approved drugs sold in the state that have a WAC of at least $100 for a 30-day supply. Additionally, within 30 days of a 40 percent or more price increase over the preceding three years or a 15 percent or more price increase over the preceding year, a manufacturer must submit pricing information.
Description: This measure specifies that a pharmacy benefit manger (PBM) has a fiduciary responsibility to an insurer and requires a PBM to report information about rebates and administrative fees in aggregate to Utah’s Insurance Department.
Adopted: June 18, 2019 Sponsor: House Appropriations Committee
Description: This measure serves as the budget. This bill directs the Agency of Human Services to extend the deadline by which the agency must implement a wholesale drug importation program. On or before Jan. 15, 2020, the Board of Pharmacy must provide findings on whether any new prescription drug wholesaler license categories would be necessary in order to operate the program.
Approved: March 21, 2019 Sponsor: Sen. Siobhan Dunnavant, Rep. Timothy Hugo
Description: This measure requires any carrier issuing a health plan to count any payments made by another person on the enrollee’s behalf, as well as payments made by the enrollee, when calculating the enrollee’s overall contribution to any out-of-pocket cost-sharing requirement under the carrier’s health plan.
Description: This measure requires pharmaceutical manufacturers to disclose certain pricing information. Each year, each health plan issuer must submit to the data organization the 25 most-prescribed drugs, the 25 costliest drugs by total plan spending, the 25 drugs with the highest year-over-year increase in spending, and a summary analysis of the impact on drug costs on health premiums. Manufacturers must submit annually a description of the factors used to make the decision to increase the wholesale acquisition cost (WAC) of the drug and the amount of the increase, along with a justification for the increase. Manufacturers will only be required to submit this information for drugs that will enter the market at a WAC of $10,000 or more or is currently on the market and has a WAC of more than $100 and the WAC increases by at least 20 percent in one year or 50 percent in three years. Additionally, manufacturers must provide 60 day’s advanced notice of a qualifying price increase. Manufacturers must also submit notice informing the Washington Health Authority when a manufacturer files a new drug application or biologics license. This measure also requires a pharmacy benefit manager (PBM) to submit an annual transparency report. This measure requires that pharmacy services administrative organizations submit an annual report that includes the negotiated reimbursement rate of the 25 drugs with the highest reimbursement rate and the 25 drugs with the largest year-to-year change in reimbursement rate.
Approved: March 9, 2019 Sponsor: Del. Matthew Rohrbach
Description: This measure requires that when calculating an insured individual’s contribution to any applicable cost-sharing requirement, including the annual limitation on cost sharing, a pharmacy benefit manager, or insurer must include any cost-sharing amounts paid by the insured or on behalf of the insured by another person.
Approved: February 26, 2019 Sponsor: Rep. Dan Kirkbridge
Description: This measure prohibits a pharmacy benefit manager from prohibiting or penalizing a pharmacy or pharmacist for informing a covered person about a lower cost, including the cash price. This measure also allows a pharmacist to offer an individuals a more affordable alternative to the prescribed drug if one is available.
Approved: Sept. 4, 2018 Sponsor: Rep. David Guttenberg
Description: Requires pharmacy benefit managers to register biennially as third-party administrators with the state’s Division of Insurance and establishes rules for pharmacy audits and calculating pharmacy overpayments and underpayments based on actuals rather than estimates. This measure requires pharmacy benefit managers to disclose methodology and sources for drug reimbursement amounts and to establish appeals process for reimbursement of multi-source drugs.
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.
Approved: March 15, 2018 Sponsor: Rep. Michelle Gray
Description: Requires pharmacy benefit managers to register to obtain licensing. Prohibits pharmacy benefit managers from using untrue, deceptive, or misleading solicitations or advertisements. Prohibits pharmacy benefit managers from requiring accreditation or certification. Prohibits pharmacy benefit managers from paying a pharmacy benefit manager’s own pharmacy or pharmacist more than they pay an Arkansas pharmacy or pharmacist for providing the same pharmacist services. Prohibits pharmacy benefit managers from placing a “gag” order restricting the pharmacy or pharmacist from sharing data with a patient and government entities.
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.
Description: This measure requires a pharmacy to inform a customer whether the retail price for a covered prescription is lower than the applicable cost-sharing amount, and would make a contract provision that is inconsistent with these provisions void.
Description: This measure requires a pharmacy to inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable cost-sharing amount for the drug. Payment rendered by an enrollee would constitute the applicable cost sharing. This measure also requires a pharmacy benefit manager to disclose certain information with respect to prescription product benefits specific to the purchaser, including the aggregate wholesale acquisition costs from a manufacturer or labeler and any administrative fees received from a manufacturer or labeler. This bill establishes the Task Force on Pharmacy Benefit Management Reporting to determine what information related to pharmaceutical costs the department should be required to report.
Approved: Sept. 26, 2018 Sponsor: Sen. Scott Wiener
Description: This measure extends the sunset date of a requirement that puts a cap on the cost sharing of a covered outpatient prescription drug at $250 per 30-day supply. This measure also requires health plan contracts or health insurance policies to cover medically necessary drug treatments for HIV and AIDS until 2023.
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.
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.
Approved: Aug. 28, 2018 Sponsor: Rep. Andria Bennett
Description: Prevents pharmacy benefit managers from prohibiting pharmacies from disclosing the cost of prescription medications, cost-sharing information, or the availability of alternative medications to consumers.
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.
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.
Approved: June 1, 2018 Sponsor: Sen. Mark Costello
Description: This measure is a budget bill that contains a provision (Section 140) that permits a pharmacy or pharmacist to provide a covered individual with information regarding the amount of the covered individual’s cost share for a prescription drug. This measure also restricts pharmacy benefit managers from prohibiting a pharmacy or pharmacist from discussing cost information with a covered individual or from selling a more affordable alternative. This measure also prohibits a health benefit plan from requiring a covered individual to pay a copayment for pharmacy benefits that exceeds the pharmacy’s or pharmacist’s submitted charges.
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.
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.
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.
Description: Prohibits a pharmacy benefit manager from prohibiting a pharmacy or pharmacist from informing a patient of all relevant options when they are acquiring their prescription medication, including the cost and clinical efficacy or of a more affordable drug and whether cash payment for the drug is less than an insurance copayment.
Description: Stipulates that in the case of a health insurance issuer that offers or renews a health benefit plan. if the health insurance issuer may charge enrollees cost-sharing amounts that may result in an excess consumer cost burden for covered prescription drugs, the insurance issuer must disclose to enrollees the fact that there will be an excess cost burden. It also requires a health insurance issuer that offers or renews a health benefit plan to annually make available information regarding the value of rebates expressed as a percentage that the health insurance issue made available to enrollees at the point of sale.
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.
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.
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.
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.
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.
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.
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.
Description: This measure prohibits a PBM from including a provision in a contract with a pharmacy or pharmacist that requires a covered person to make a payment for a prescription drug at the point of sale in an amount that exceeds the lesser of the copayment or the cash price. This measure also allows a pharmacist to provide a covered person cost sharing information and information about alternative medications.
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.
Description: Establishes a commission charged with studying how the state might achieve greater transparency in pharmaceutical drug costs and the roles of pharmacy benefit managers in cost, administration, and distribution of prescription drugs. The commission will analyze critical prescription drugs and their role in overall health care spending and will identify the amounts rebated by drug manufacturers for certain high-cost or highly-used prescription drugs. The goal is to determine if any changes to New Hampshire laws could reduce the rising cost of pharmaceuticals to purchasers or patients.
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.
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).
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.
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.
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.
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.”
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.
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.
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.
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.
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.
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.
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.
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.
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.
Description: This bill prohibits the distribution of manufacturer-sponsored drug coupons when other US Food and Drug Administration-approved lower-cost generic drugs are available, covered under an individual’s health plan, and are not otherwise contraindicated for the condition for which the prescription drug is approved.
Approved: October 9, 2017 Sponsor: Sen. Ed Hernandez
Description: This measure 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. This measure also requires all insurers to include in their yearly report specified drugs which make up the highest share of spending. This measure requires pharmacy benefit managers who receive a notice of an increase in wholesale acquisition cost to notify their public and private purchasers of the increase.
Approved: October 1, 2017 Sponsor: Committee on Public Health
Description: This measure 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). This measure also prohibits health carrier or pharmacy benefit manager from requiring an individual to pay for a covered prescription in an amount greater than the lesser of: the applicable copayment, the allowable claim amount, or the amount individuals would pay for the drug if they had no insurance plan, benefits, or discounts. This measure authorizes the insurance commissioner to audit pharmacy services’ contracts for compliance and to enforce violations by voiding contracts that contain unfair trade practices.
Approved: June 9, 2017 Sponsor: Rep. Clay Yarborough
Description: This measure requires the Florida 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, which must be updated monthly. When a generic is available, the price data will be reported for both the generic and the equivalent brand name drug and be made available on the agency’s internet website for each pharmacy to use.
Approved: July 1, 2017 Sponsor: Rep. David Knight & Sen. Jeff Mullis
Description: This measure authorizes the Georgia Commissioner of Insurance to promulgate rules and regulations to prohibit pharmacy benefit managers (PBMs) from requiring the use of mail-order pharmacies. This measure bans the PBM practice that prohibits a pharmacist or pharmacy from providing an insured patient information about 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 a pharmacy nor a pharmacist will be penalized for sharing information or for selling a more affordable alternative if one is available. This measure prohibits PBMs from charging or collecting from an insured a copayment that exceeds the total submitted charges by the network pharmacy for which the pharmacy is paid.
Approved: June, 20, 2017 Sponsor: Rep. Dee Morikawa & Sen. Rosalyn Baker
Description: This measure 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.
Description: This measure requires each drug manufacturer or pharmaceutical marketer who engages in any form of prescription drug marketing to a prescriber to provide to the Louisiana Board of Pharmacy the current wholesale acquisition cost information for each of the drugs marketed in the state by that manufacturer.
Approved: July 24, 2018 Sponsor: Sen. Troy Jackson
Description: This measure requires drug manufacturers licensed in Maine to make a drug distributed within the state available for sale to eligible product developers so that those product developers can conduct the testing required to support an application for approval of a drug.
Approved: June 1, 2017 Sponsor: Sen. Ellen Spiegel
Description: This measure prohibits insurers from moving a prescription drug from a lower-cost tier to a higher-cost tier, except on specified dates or when an applicable generic drug is added to the formulary.
Approved: June 15, 2017 Sponsor: Sen. Michael Roberson
Description: This measure requires the Department of Health and Human Services to compile lists of prescription drugs that are used to treat diabetes. This measure requires manufacturers and PBMs that sell diabetes drugs to provide specified information to the Department which would keep proprietary information confidential. Under this measure, manufacturers must submit a list of each sales representative who markets prescription drugs in this state. 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.
Description: This is the 2018 Health and Mental Hygiene budget. This measure institutes a separate Medicaid drug cap as part of the state’s global spending cap for Medicaid. If the state’s spending is expected to exceed the annual limit, this law gives the Medicaid program the authority to negotiate with drug companies for supplemental rebates. If the state is unable to reach an agreement for supplemental rebates, certain drugs may be referred to the New York Drug Utilization Review Board, which conducts a “value assessment” of the product. Based on that assessment, the board could recommend a target amount for a manufacturer’s “supplemental rebate” to reduce the drug’s cost. If a supplemental rebate agreement is not reached at this point, the drug could be removed from the managed care program formulary.
Description: This measure protects pharmacies and pharmacists from certain fees and limits patients’ out-of-pocket spending. Under this measure, a pharmacy benefits manager cannot charge a patient a copayment that exceeds the cost of the medication. Also, this measure allows a pharmacy to share prescription drug cost information with patients.
Approved: April 5, 2017 Sponsor: Sen. Howard Anderson
Description: This measure requires a pharmacy benefit manager to disclose to a plan sponsor any difference between the amount paid to a pharmacy and the amount charged to the plan sponsor, upon request by a plan sponsor contract payer.
Description: This measure requires pharmacy benefit managers to register with the Insurance Commission prior to conducting business in the state. This measure also establishes the procedure for conducting pharmacy audits.