HCS/HB 1542 - Under this act, no pharmacy benefits manager (PBM) shall charge or collect from a covered person a co-payment for a prescription or pharmacy service that exceeds the amount retained by the pharmacists or pharmacy from all payment sources for filling a prescription or providing the service. No PBM shall prohibit a contracted pharmacist or pharmacy from informing a covered person of the difference between the co-payment and the amount the person would pay if the person did not use a health benefit plan to cover the cost, or from selling a prescription drug to a covered person who chooses not to use a health benefit plan to cover the cost if the cost to the person is less. No PBM shall restrict or interfere with a pharmacist's ability to provide pharmacy care to a covered person, including with regard to pharmacist-patient communications or discussion of alternative drug options.
Additionally, no PBM shall, directly or indirectly, charge or hold a pharmacist or pharmacy responsible for any fee amount related to a claim where the amount of the fee is not known as the time of adjudication. No PBM shall prohibit a pharmacist or pharmacy from making any written or oral statement to any state, county, or municipal official or committee, body, or proceeding.
Any person aggrieved by a PBM's violation of this provision may bring a civil action. If a person believes that a PBM violated certain prohibitions in this provision, they may mail written notice to the PBM describing the alleged violation and allow the PBM 10 business days to remedy the alleged violation. If the violation is not remedied, then the person may request the Department to conduct an arbitration and the Department shall issue a ruling within 70 days of receiving the request, which shall be final and binding on all parties. The Department may join similar claims. The Department may establish a reasonable fee to be paid by the non-prevailing party.
This act is similar to provisions in CCS/HCS/SS/SCS/SB 826 (2018).
ERIC VANDER WEERD