HB 1606

Bill Subjects

Agencies; Department Of Insurance (Idoi) Civil Law And Procedure; Liabilities, Damages, And Penalties Health Care Facilities; Pharmacies Insurance; Generally

Abstract

Prohibits a pharmacy benefit manager from taking certain actions. Requires a pharmacy benefit manager to submit a report to the insurance commissioner every six months. (Current law requires a pharmacy benefit manager to submit the report annually.) Provides that if a contract holder requests an audit of compliance with the contract from a pharmacy benefit manager, the pharmacy benefit manager must provide the audit requested to the contract holder not later than 30 business days after receiving the request. Removes the provision specifying that the files or forms disclosed to the contract holder by the pharmacy benefit manager as part of an audit of compliance with the contract may be modified to redact trade secrets. Establishes civil penalties that the department of insurance (department) shall impose for a violation of the provisions concerning pharmacy benefit managers. Requires a pharmacy benefit manager to provide additional information in the pharmacy benefit manager's report to the department. Requires, after June 30, 2025, a health payer to include information relating to prescription drug pricing in the data submitted to the all payer claims data base by the health payer. Requires a health plan to credit toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the covered individual pays directly to any health care provider for a medically necessary covered health care service if a claim for the health care service is not submitted to the health plan and the amount paid by the covered individual to the health care provider is less than the average discounted rate for the health care service paid to a health care provider in the health plan's network.