HB 943

Abstract

Health insurance; retail community pharmacies.Requires a carrier to administer its health benefit plans in a mannerconsistent with certain requirements and to include such requirementsin its provider contracts addressing the provision of pharmacy benefitsmanagement. The bill provides that (i) a covered individual is permittedto fill any mail order-covered prescription, at the covered individual'soption, at any mail order pharmacy or network participating retailcommunity pharmacy under certain conditions; (ii) the carrier orpharmacy benefits manager is prohibited from imposing a differentialcopayment, additional fee, rebate, bonus, or other condition on anycovered individual who elects to fill his prescription at an in-network retail community pharmacy that is not similarly imposed on coveredindividuals electing to fill a prescription from a mail order pharmacy;and (iii) the pharmacy benefits manager is required to expresslydisclose to the carrier in the contract if the pharmacy benefitsmanager retains all or a greater portion of a drug manufacturer'srebate amount or any additional direct or indirect remuneration fromany third party for drugs dispensed through the pharmacy benefitsmanager-owned mail order pharmacy than the pharmacy benefits managerdoes for drugs dispensed through a retail community pharmacy. Thebill also removes the exemption for a self-insured or self-fundedemployee welfare benefit plan under provisions regulating pharmacybenefits managers.