SB 568

Abstract

Medical assistance services; managed care organization contracts with pharmacy benefits managers; spread pricing. Requires the Department of Medical Assistance Services to require a managed care organization with which the Department enters into an agreement for the delivery of medical assistance services to include in any agreement between the managed care organization and a pharmacy benefits manager provisions prohibiting the pharmacy benefits manager or a representative of the pharmacy benefits manager from conducting spread pricing with regard to the managed care organization's managed care plans. The bill defines "spread pricing" as the model of prescription drug pricing in which the pharmacy benefits manager charges a managed care plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services. The bill applies to agreements entered into, amended, extended, or renewed on or after July 1, 2020. This bill is identical to HB 1291.

Medical assistance services; managed care organization contracts with pharmacy benefits managers; spread pricing. Requires the Department of Medical Assistance Services to require a managed care organization with which the Department enters into an agreement for the delivery of medical assistance services to include in any agreement between the managed care organization and a pharmacy benefits manager provisions prohibiting the pharmacy benefits manager or a representative of the pharmacy benefits manager from conducting spread pricing with regard to the managed care organization's managed care plans. The bill defines "spread pricing" as the model of prescription drug pricing in which the pharmacy benefits manager charges a managed care plan a contracted price for prescription drugs and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services. The bill applies to agreements entered into, amended, extended, or renewed on or after January 1, 2021.

Board of Medical Assistance Services; state pharmacy benefits manager. Requires the Board of Medical AssistanceServices (the Board) to select, every four years, a third-party administratorto serve as the state pharmacy benefits manager used by Medicaidmanaged care organizations under the state plan for medical assistance.Under the bill, the state pharmacy benefits manager is responsiblefor all claims under the state plan. The bill requires the Board,in selecting the state pharmacy benefits manager, to establish eligibilitycriteria, develop a master contract to be used between the statepharmacy benefits manager and a Medicaid managed care organization,and establish mandatory disclosures for the applicants. The billrequires the state pharmacy benefits manager, in consultation withthe Director of Medical Assistance Services (the Director), to developa drug formulary for use when administering prescribed drug benefits on behalf of a Medicaid managed care organization under the stateplan. The bill prohibits payments for drugs that exceed the per unitprice on the formulary. The bill requires the Director to establishan appeals process by which pharmacies may appeal any disputes relatingto the maximum allowable cost set by the state pharmacy benefitsmanager. The bill requires the state pharmacy benefits manager toprovide a quarterly report to the Board containing certain information.