PRINTER'S NO. 3855
No. 2695 Session of 2000
INTRODUCED BY ALLEN, TRELLO, WRIGHT, ARMSTRONG, BAKER, BELARDI,
BENNINGHOFF, L. I. COHEN, M. COHEN, CORRIGAN, CURRY, DALLY,
FAIRCHILD, FRANKEL, HALUSKA, HARHAI, HARHART, HESS, KENNEY,
LUCYK, McILHATTAN, S. MILLER, PHILLIPS, READSHAW, SATHER,
SHANER, STABACK, STERN, J. TAYLOR, TIGUE, TULLI, WILT AND
YOUNGBLOOD, AUGUST 21, 2000
REFERRED TO COMMITTEE ON INSURANCE, AUGUST 21, 2000
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.
17 (2) Prescription services provided under medical
1 assistance or the Pharmaceutical Assistance Contract for the
2 Elderly (PACE).
3 (3) A nonprofit hospital or medical service corporation
4 contract.
5 (4) A health maintenance organization subscriber
6 contract.
7 (5) A plan provided by a multiple employer welfare
8 arrangement.
9 (6) A plan provided by another benefit arrangement, to
10 the extent permitted by the Employee Retirement Income
11 Security Act of 1974 (Public Law 93-406, 88 Stat. 829), or by
12 any waiver of or other exception to that act provided under
13 Federal law or regulation.
14 Section 3. Prescription drug cash discount cards.
15 (a) Unlawful practices.--It shall be unlawful and a
16 violation of this act for any person to sell, market, promote,
17 advertise or otherwise distribute any card or other purchasing
18 mechanism or device, which is not insurance, that purports to
19 offer discounts or access to discounts from pharmacies for the
20 purchase or receipt of prescription drugs or devices where:
21 (1) The card or other purchasing mechanism or device
22 does not expressly provide in bold and prominent type that
23 the discounts are not an insurance benefit.
24 (2) The discounts are not specifically authorized by an
25 individual and separate contract with each pharmacy listed in
26 conjunction with the card or other purchasing mechanism or
27 device.
28 (3) The discounts or access to discounts offered or the
29 range of discounts or access to the range of discounts
30 offered are misleading, deceptive or fraudulent, regardless
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1 of the literal wording used.
2 (b) Construction.--Nothing in this section shall be
3 construed to apply to a customer discount or membership card
4 issued by a pharmacy.
5 Section 4. Uniform prescription drug beneficiary identification
6 card.
7 (a) General rule.--A health benefit plan that provides
8 coverage for prescription drugs or devices or the administrator
9 of such a plan, including, but not limited to, third-party
10 administrators for self-insured plans and State-administered
11 plans, shall issue to the beneficiaries of the coverage an
12 identification card, purchasing device or mechanism which, at a
13 minimum, shall include the following information:
14 (1) Name or logo of the plan or benefit administrator
15 issuing the identification card. This information is to be
16 located at the top, front side of the identification card.
17 (2) Beneficiary name or names and identification number
18 or numbers. This information is to be left justified and
19 located on the front side of the identification card.
20 (3) Name and address of the administrator to be used for
21 sending nonelectronic prescription claims or other patient or
22 provider correspondence. This information is to be located on
23 the reverse side of the identification card.
24 (4) Telephone number that providers may call for
25 assistance. This information is to be located on the reverse
26 side of the identification card.
27 (5) Complete electronic transaction routing information
28 including, at a minimum, the international identification
29 number. Processor control numbers and group numbers are
30 required if needed by the benefit administrator to
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1 electronically process the prescription claim. This
2 information is to be left justified and located on the front
3 side of the identification card.
4 (6) Any additional information required by the plan or
5 benefit administrator to process a prescription claim.
6 (b) Format standards.--The format of the identification
7 card, purchasing device or mechanism shall further conform to
8 standards approved by the National Council for Prescription Drug
9 Programs (NCPDP) or to a nationally recognized format approved
10 by the Insurance Commissioner.
11 (c) Card issuance.--A new uniform prescription drug
12 beneficiary identification card, purchasing device or mechanism
13 as required under subsection (a) shall be issued by health
14 benefit plans or administrators to beneficiaries upon enrollment
15 and reissued on the occasion of any change in benefits or other
16 elements contained within the identification card, purchasing
17 device or mechanism.
18 Section 5. Remedies and penalties.
19 (a) Injunctive relief and damages.--The Insurance
20 Commissioner, Attorney General or any person, firm, private
21 corporation, municipal or public corporation or trade
22 association may maintain an action to enjoin a continuance of
23 any acts in violation of this act and for the recovery of
24 damages.
25 (b) Application of unfair insurance practices act.--A
26 violation of this act shall constitute a violation of the act of
27 July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance
28 Practices Act, and shall be subject to the administrative and
29 civil penalties contained in that act.
30 Section 6. Effective date.
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1 This act shall take effect as follows:
2 (1) Section 4 shall take effect January 1, 2001.
3 (2) The remainder of this act shall take effect
4 immediately.
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