HB560:

Health insurance; retail community pharmacies.

Bill Summary:

Health insurance; retail community pharmacies.
Requires a carrier to administer its health benefit plans in a manner
consistent with certain requirements and to include such requirements
in its provider contracts addressing the provision of pharmacy benefits
management. The bill provides that (i) a covered individual is permitted
to fill any mail order-covered prescription, at the covered individual's
option, at any mail order pharmacy or network participating retail
community pharmacy under certain conditions; (ii) the carrier or
pharmacy benefits manager is prohibited from imposing a differential
copayment, additional fee, rebate, bonus, or other condition on any
covered individual who elects to fill his prescription at an in-network
retail community pharmacy that is not similarly imposed on covered
individuals electing to fill a prescription from a mail order pharmacy;
and (iii) the pharmacy benefits manager is required to expressly
disclose to the carrier in the contract if the pharmacy benefits
manager retains all or a greater portion of a drug manufacturer's
rebate amount or any additional direct or indirect remuneration from
any third party for drugs dispensed through the pharmacy benefits
manager-owned mail order pharmacy than the pharmacy benefits manager
does for drugs dispensed through a retail community pharmacy. The
bill also removes the exemption for a self-insured or self-funded
employee welfare benefit plan under provisions regulating pharmacy
benefits managers.