HB 834 Enacts provisions relating to payments for prescription drugs

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Current Bill Summary

- Prepared by Senate Research -

HB 834 - This act enacts provisions relating to payments for prescription drugs.

Before March 1, 2023, and annually thereafter, the pharmacy benefits manager ("PBM") utilized by the Missouri Consolidated Health Care Plan ("the Plan") shall file a report with the Plan for the immediately preceding calendar year regarding rebates, as defined in the act. The report shall include certain information regarding the Plan, including the aggregate dollar amount of rebates collected from pharmaceutical manufacturers, and the aggregate dollar amount of the rebates that were not passed on to the Plan. (Section 103.200.2). The Plan shall establish a form for the reporting, in consultation with its PBM, designed to minimize administrative burden and cost. (Section 103.200.3). Documents, materials, and other information submitted to the Plan under these provisions shall not be subject to disclosure, except to the extent they are reported in the aggregate. The Plan shall not disclose any information under these provisions in a manner that would compromise the financial, competitive, or proprietary nature of the information, or allow a third party to identify rebate values for a particular outpatient prescription drug. (Section 103.200.4). The Plan shall also annually report to the General Assembly the aggregate dollar amount of pharmaceutical rebates received for covered drugs utilized by enrollees during the calendar year. (Section 103.200.5(1)). Before July 1, 2023, and annually thereafter, the Plan shall produce and provide to the General Assembly and the Director of the Department of Commerce and Insurance a report for the immediately preceding calendar year describing the rebate practices of health carriers that use pharmacy benefits managers, as specified in the act. (Section 103.200.5(2)). The Plan may impose a penalty of up to $7,500 on its PBM for each violation of these provisions. (Section 103.200.6).

The act specifies that certain provisions of law pertaining to pharmacists and pharmacies shall not be construed to prohibit patients' ability to obtain prescription services from any licensed pharmacist "or pharmacy", and repeals language specifying that the provisions do not remove patients' ability to waive their freedom of choice under a contract with regard to payment or coverage of prescription expenses. (Section 338.015.1). Under the act, no PBM shall penalize or restrict a covered person from obtaining services from a contracted pharmacy, as such terms are defined in current law. (Section 335.015.4).

This act also modifies the definition of "covered person" with regard to certain statutes regarding pharmacies and PBMs to only include individuals who receive prescription drug coverage through a PBM. Additionally, the act repeals a provision of law specifying that certain PBM regulations shall not apply with regard to Medicare Part D, or other health plans regulated partly or wholly under federal law. (Former section 376.387.5). The act provides standardized definitions for the terms "generic" and "rebate" applicable to PBMs and health carriers (Section 376.387.6-7), and specifies that PBMs shall owe a fiduciary duty to any entity with which it contracts to provide pharmacy benefit management services. (Section 376.387.8).

The act repeals a portion of a definition to specify that certain provisions relating to the maximum allowable cost of a prescription drug are applicable to all pharmacies, rather than only to contracted pharmacies. (Section 376.388.1(1)). The act also repeals the definition of "health carrier" used in one iteration of the definition of "pharmacy benefits manager". (Section 376.388.1(2)). If the reimbursement for a drug to a contracted pharmacy is below the pharmacy's cost to purchase the drug, the PBM shall sustain an appeal and increase reimbursement for the pharmacy and other contracted pharmacies to cover the cost of purchasing the drug. (Section 376.388.5(2)). A PBM shall not reimburse a pharmacy or pharmacist in the state an amount less than the amount that the PBM reimburses a pharmacy benefits manager affiliate, as defined in the act, for providing the same pharmacist services. (Section 376.388.5(3)).

This act is similar to HB 1146 (2021), SB 971 (2020), HCS/HB 2412 (2020), SB 413 (2019), and HB 1165 (2019).


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