S1000B1314A04554 MSP:EJH 05/29/24 #90 A04554
AMENDMENTS TO SENATE BILL NO. 1000
Sponsor: SENATOR BROOKS
Printer's No. 1314
Amend Bill, page 1, line 8, by striking out "for short title
and"
Amend Bill, page 1, line 10, by striking out "benefits" and
inserting
benefit
Amend Bill, page 1, lines 13 through 15, by striking out all
of said lines and inserting
Section 1. The title of the act of November 21, 2016
(P.L.1318, No.169), known as the Pharmacy Audit Integrity and
Transparency Act, is amended to read:
Amend Bill, page 1, line 21, by striking out "managers" and
inserting
manager
Amend Bill, page 2, lines 2 through 5, by striking out all of
said lines
Amend Bill, page 2, lines 12 through 25, by striking out all
of said lines
Amend Bill, page 2, line 30, by striking out "PBM" and
inserting
pharmacy benefit manager
Amend Bill, page 3, line 1, by striking out "PBM" and
inserting
pharmacy benefit manager
Amend Bill, page 3, lines 2 and 3, by striking out "between
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PBM-" in line 2 and all of line 3 and inserting
for pharmacies contracted with the pharmacy benefit
manager and pharmacies that are not contracted with the
pharmacy benefit manager.
Amend Bill, page 3, line 5, by striking out "An act of" and
inserting
A practice used by
Amend Bill, page 3, line 6, by striking out "reimbursing" and
inserting
to reimburse
Amend Bill, page 3, line 6, by striking out "then billing"
and inserting
bill
Amend Bill, page 3, line 8, by inserting after "price"
than was reimbursed
Amend Bill, page 3, line 15, by striking out "PBM" and
inserting
pharmacy benefit manager
Amend Bill, page 3, line 16, by striking out "PBM" and
inserting
pharmacy benefit manager
Amend Bill, page 3, line 17, by striking out "medication" and
inserting
drug
Amend Bill, page 3, lines 20 through 30; page 4, lines 1
through 30; page 5, lines 1 through 17; by striking out all of
said lines on said pages and inserting
CHAPTER 6
PHARMACY BENEFIT MANAGER CONTRACT
REQUIREMENTS AND PROHIBITED ACTS
Section 601. Contract provisions.
A contract between a pharmacy benefit manager or a designee
of the pharmacy benefit manager and a pharmacy may not:
(1) Require participation in the pharmacy benefit
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manager's network contingent on the pharmacy receiving less
than the National Average Drug Acquisition Cost as
reimbursement for purchasing a drug.
(2) Require retroactive recoupment of money paid to a
pharmacy by the pharmacy benefit manager.
(3) Include additional fees unless disclosed and applied
at the time of the adjudication of the claim, including, but
not limited to:
(i) Transaction fees.
(ii) Chargebacks due to recalculation of the cost of
the ingredients used in a prescription drug.
(iii) Adjustments in the rates or direct and
indirect remuneration fees made by the pharmacy benefit
manager.
(4) Require contracted pharmacies to participate in
patient steering solely based on cost savings to the pharmacy
benefit manager rather than to reimburse the pharmacy at cost
plus a dispensing fee as is otherwise required by a pharmacy
contract.
Section 602. Spread pricing.
A pharmacy benefit manager may not conduct or participate in
spread pricing.
Section 603. Patient steering.
A pharmacy benefit manager may not conduct or participate in
patient steering, including requiring that patients or any or
all of the patients' prescriptions be referred to a mail-order
pharmacy or an affiliate pharmacy of the pharmacy benefit
manager.
Section 604. Duties of the department.
The department shall:
(1) Develop a process for receiving, hearing and
resolving complaints a pharmacy files against a pharmacy
benefit manager.
(2) Establish licensure requirements and regulate
pharmacy benefit managers, notwithstanding ownership or
affiliation with any other entity already licensed by this
Commonwealth, operating or exercising contracts in this
Commonwealth.
(3) Establish a reimbursement rate no less than the
Medicare dispensing fee established by the Centers for
Medicare and Medicaid Services to be reimbursed to pharmacies
contracting with pharmacy benefit managers, notwithstanding
specialty status, ownership or sale of brand-name products.
(4) Ensure, through regulation and auditing, that no
pharmacy be reimbursed less than the cost of a drug.
Section 605. Duties of pharmacy benefit managers.
Pharmacy benefit managers shall:
(1) Review requests from a pharmacy to join the network
of the pharmacy benefit managers and approve or deny the
requests in writing within 30 days of the date of each
request. If a pharmacy's request is denied, the pharmacy
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benefit manager must provide its reasoning for the denial
within the correspondence issued to the pharmacy.
(2) Provide a dedicated telephone number and email
address for handling network requests and customer service
needs that is staffed during normal business hours for the
benefit of pharmacies.
Section 606. Reports by pharmacy benefit manager.
A pharmacy benefit manager shall submit a quarterly report to
the department of the total number of rebates, rebate amounts
and payments received from drug manufacturers and an explanation
of how the rebates and payments were distributed by the pharmacy
benefit manager. If audits required under section 604(4)
determine that a pharmacy was reimbursed less than the cost of
acquiring and dispensing a drug, the department shall have the
authority to require the pharmacy benefit manager to recoup the
loss from the manufacturer rebates received and require that the
amount of the loss be paid to the pharmacy within 30 days of the
audit submission.
Section 5. This act applies to contracts entered into or
renewed on or after the effective date of this section.
Amend Bill, page 5, line 18, by striking out "5" and
inserting
6
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