PRINTER'S NO. 1383
No. 1177 Session of 2005
INTRODUCED BY ALLEN, BELFANTI, PHILLIPS, ARGALL, BAKER, BARRAR, BOYD, CALTAGIRONE, CAPPELLI, CAWLEY, DALLY, DeWEESE, GEIST, GEORGE, GOODMAN, HENNESSEY, HERMAN, HERSHEY, HESS, R. MILLER, SCAVELLO, SEMMEL, SHANER, STABACK, TANGRETTI, E. Z. TAYLOR, THOMAS, TIGUE, WILT, WOJNAROSKI, YOUNGBLOOD AND PALLONE, MARCH 29, 2005
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, MARCH 29, 2005
AN ACT 1 Providing for the content and format of a uniform prescription 2 drug beneficiary identification card, for prohibitions 3 relating to discounts from pharmacies and for remedies and 4 penalties. 5 The General Assembly of the Commonwealth of Pennsylvania 6 hereby enacts as follows: 7 Section 1. Short title. 8 This act shall be known and may be cited as the Uniform 9 Prescription Drug Beneficiary Identification Card Act. 10 Section 2. Definitions. 11 The following words and phrases when used in this act shall 12 have the meanings given to them in this section unless the 13 context clearly indicates otherwise: 14 "Health benefit plan." Includes: 15 (1) An accident and health insurance policy or 16 certificate.
1 (2) Prescription services provided under medical 2 assistance or the Pharmaceutical Assistance Contract for the 3 Elderly (PACE). 4 (3) A nonprofit hospital or medical service corporation 5 contract. 6 (4) A health maintenance organization subscriber 7 contract. 8 (5) A plan provided by a multiple employer welfare 9 arrangement. 10 (6) A plan provided by another benefit arrangement, to 11 the extent permitted by the Employee Retirement Income 12 Security Act of 1974 (Public Law 93-406, 88 Stat. 829), or by 13 any waiver of or other exception to that act provided under 14 Federal law or regulation. 15 Section 3. Prescription drug cash discount cards. 16 (a) Unlawful practices.--It shall be unlawful and a 17 violation of this act for any person to sell, market, promote, 18 advertise or otherwise distribute any card or other purchasing 19 mechanism or device, which is not insurance, that purports to 20 offer discounts or access to discounts from pharmacies for the 21 purchase or receipt of prescription drugs or devices where: 22 (1) The card or other purchasing mechanism or device 23 does not expressly provide in bold and prominent type that 24 the discounts are not an insurance benefit. 25 (2) The discounts are not specifically authorized by an 26 individual and separate contract with each pharmacy listed in 27 conjunction with the card or other purchasing mechanism or 28 device. 29 (3) The discounts or access to discounts offered or the 30 range of discounts or access to the range of discounts 20050H1177B1383 - 2 -
1 offered are misleading, deceptive or fraudulent, regardless 2 of the literal wording used. 3 (b) Construction.--Nothing in this section shall be 4 construed to apply to a customer discount or membership card 5 issued by a pharmacy. 6 Section 4. Uniform prescription drug beneficiary identification 7 card. 8 (a) General rule.--A health benefit plan that provides 9 coverage for prescription drugs or devices or the administrator 10 of such a plan, including, but not limited to, third-party 11 administrators for self-insured plans and State-administered 12 plans, shall issue to the beneficiaries of the coverage an 13 identification card, purchasing device or mechanism which, at a 14 minimum, shall include the following information: 15 (1) Name or logo of the plan or benefit administrator 16 issuing the identification card. This information is to be 17 located at the top, front side of the identification card. 18 (2) Beneficiary name or names and identification number 19 or numbers. This information is to be left justified and 20 located on the front side of the identification card. 21 (3) Name and address of the administrator to be used for 22 sending nonelectronic prescription claims or other patient or 23 provider correspondence. This information is to be located on 24 the reverse side of the identification card. 25 (4) Telephone number that providers may call for 26 assistance. This information is to be located on the reverse 27 side of the identification card. 28 (5) Complete electronic transaction routing information 29 including, at a minimum, the international identification 30 number. Processor control numbers and group numbers are 20050H1177B1383 - 3 -
1 required if needed by the benefit administrator to 2 electronically process the prescription claim. This 3 information is to be left justified and located on the front 4 side of the identification card. 5 (6) Any additional information required by the plan or 6 benefit administrator to process a prescription claim. 7 (b) Format standards.--The format of the identification 8 card, purchasing device or mechanism shall further conform to 9 standards approved by the National Council for Prescription Drug 10 Programs (NCPDP) or to a nationally recognized format approved 11 by the Insurance Commissioner. 12 (c) Card issuance.--A new uniform prescription drug 13 beneficiary identification card, purchasing device or mechanism 14 as required under subsection (a) shall be issued by health 15 benefit plans or administrators to beneficiaries upon enrollment 16 and reissued on the occasion of any change in benefits or other 17 elements contained within the identification card, purchasing 18 device or mechanism. 19 Section 5. Remedies and penalties. 20 (a) Injunctive relief and damages.--The Insurance 21 Commissioner, Attorney General or any person, firm, private 22 corporation, municipal or public corporation or trade 23 association may maintain an action to enjoin a continuance of 24 any acts in violation of this act and for the recovery of 25 damages. 26 (b) Application of unfair insurance practices act.--A 27 violation of this act shall constitute a violation of the act of 28 July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance 29 Practices Act, and shall be subject to the administrative and 30 civil penalties contained in that act. 20050H1177B1383 - 4 -
1 Section 6. Effective date. 2 This act shall take effect as follows: 3 (1) Section 4 shall take effect January 1, 2006. 4 (2) The remainder of this act shall take effect 5 immediately. A20L40JS/20050H1177B1383 - 5 -