PRINTER'S NO. 2467
No. 1902 Session of 2001
INTRODUCED BY WALKO, DeLUCA, GORDNER, LEDERER, BELARDI, HARHAI,
FAIRCHILD, LAUGHLIN, TRICH, MACKERETH, SOLOBAY, SHANER,
BROWNE, SURRA, LEVDANSKY, MUNDY, BELFANTI, SCRIMENTI,
WANSACZ, MANDERINO, PALLONE, PETRONE, RUFFING, MELIO,
KIRKLAND, CAWLEY, CAPPELLI, COSTA, M. COHEN, GEORGE, TIGUE,
GRUCELA, CORRIGAN, HENNESSEY, BEBKO-JONES, BISHOP, COLAFELLA,
SATHER, CLARK, SANTONI, BLAUM, ROEBUCK, TANGRETTI, JOSEPHS,
CURRY, C. WILLIAMS, STURLA, J. WILLIAMS, FRANKEL, THOMAS AND
FREEMAN, SEPTEMBER 18, 2001
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
SEPTEMBER 18, 2001
AN ACT
1 Establishing the Pharmacy Best Practices and Cost Control
2 Program; and permitting the Commonwealth to enter into
3 prescription drug fair pricing coalitions.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Short title.
7 This act shall be known and may be cited as the Prescription
8 Drug Fair Pricing Coalition Act.
9 Section 2. Definitions.
10 The following words and phrases when used in this act shall
11 have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "Department." The Department of Public Welfare of the
14 Commonwealth.
1 Section 3. Participation.
2 The department may participate in a prescription drug fair-
3 pricing coalition with any state by establishing the
4 Pennsylvania Pharmacy Best Practices and Cost Control Program if
5 the other state has a similar program.
6 Section 4. Purpose.
7 The purpose of the Pharmacy Best Practices and Cost Control
8 Program shall be to promote cost-effective, high-quality
9 prescribing practices for physicians and other health care
10 professionals who prescribe, dispense or administer prescription
11 drugs.
12 Section 5. Application.
13 The Pennsylvania Pharmacy Best Practices and Cost Control
14 Program shall apply to all publicly funded prescription programs
15 provided by the Commonwealth and shall be open to participation
16 by any private health benefit plan operating within this
17 Commonwealth that shall agree to participate in it.
18 Section 6. Elements.
19 The program shall provide for the following:
20 (1) Drug utilization review procedures, including
21 standards for reviewing early prescription refills, duplicate
22 prescriptions and quality and supply controls.
23 (2) Utilization management procedures, including
24 education programs for prescribers and patients, and fraud
25 and abuse controls.
26 (3) Clinical management procedures, including clinical
27 protocols and step therapy and prior authorization of
28 limited-use drugs and drugs having a lower-cost generic or
29 therapeutic equivalent.
30 (4) Formulary and rebate management, including rebate
20010H1902B2467 - 2 -
1 agreements with pharmaceutical manufacturers.
2 (5) Any other activity relating to containment of costs
3 and quality maintenance in prescription drug therapies.
4 Section 7. Third-party administration.
5 The department may contract with a public or private third
6 party to administer all or any portion of the program.
7 Section 8. Pharmacy benefit manager disclosure.
8 No contract shall be entered into with a private party for
9 administration pursuant to the Pennsylvania Pharmacy Best
10 Practices and Cost Control Program unless the department first
11 concludes that the financial and medical interests of the
12 Commonwealth and any beneficiaries will not be adversely
13 affected by the agreement, taking into consideration whether the
14 agreement will:
15 (1) Favor any manufacturer's products over others.
16 (2) Allow a manufacturer and a pharmacy benefit manager
17 to share in manufacturer rebates and discounts.
18 (3) Allow a pharmacy benefit manager to receive any
19 economic benefit other than provided by the contract with the
20 state.
21 (4) Allow a pharmacy benefit manager to share revenue
22 with any mail order or Internet pharmacy company.
23 (5) Allow a pharmacy benefit manager to sell, share or
24 otherwise provide prescription drug data concerning
25 beneficiaries or the prescribing practices of health care
26 providers.
27 (6) Affect the financial or medical interests of
28 beneficiaries.
29 Section 9. Nonpreferred drugs.
30 (a) Ineffectiveness.--When a prescription calls for a drug
20010H1902B2467 - 3 -
1 which is not provided for on the formulary or which is not the
2 preferred drug on the formulary, coverage shall be authorized as
3 if it were on the formulary or were the preferred drug on the
4 formulary, if the formulary or preferred choice drug has been
5 ineffective or is reasonably expected to be ineffective in
6 treating the patient's condition or causes or is reasonably
7 expected to cause adverse or harmful reactions in the patient.
8 (b) Additional cost.--When a prescription calls for a drug
9 not provided for on the formulary or which is not the preferred
10 drug on the formulary, coverage shall be authorized as if it
11 were on the formulary or the preferred drug on the formulary if
12 the patient agrees to pay any additional cost under the
13 patient's health benefit plan.
14 Section 10. Annual report.
15 By October 31, 2001, and each October 31 thereafter, the
16 department shall issue a report on the implementation, use and
17 activities of the Pennsylvania Pharmacy Best Practices and Cost
18 Control Program to the chair and minority chair of the Aging and
19 Youth Committee of the Senate, the chair and minority chair of
20 the Public Health and Welfare Committee of the Senate, the chair
21 and minority chair of the Aging and Older Adult Services
22 Committee of the House of Representatives and the chair and
23 minority chair of the Health and Human Services Committee of the
24 House of Representatives.
25 Section 11. Effective date.
26 This act shall take effect in 60 days.
H3L35MSP/20010H1902B2467 - 4 -