Relating to price transparency for prescription drugs and cost-sharing calculations by carriers, and including applicability provisions

This bill relates to price transparency for prescription drugs and cost-sharing calculations by carriers. The bill requires a manufacturer to file an annual report with the commissioner of insurance (commissioner) that discloses the wholesale acquisition cost for all prescription drugs manufactured by the manufacturer that were sold to a person in this state in the immediately preceding calendar year. “Wholesale acquisition cost” or “cost” is defined in the bill as the manufacturer’s list price for a prescription drug for wholesalers or direct purchasers in the United States, not including prompt pay or other discounts, rebates, or reductions in price, for the most recent month for which the information is available, as reported in wholesale price guides or other publications of drug or biological pricing data. Within calendar days of receipt, the commissioner is required to publish this information from the annual reports on a publicly accessible internet site. If a prescription drug sold to a person in this state has a cost of $100 or more for a 30-day supply and the cost increases percent or more over the three preceding calendar years, or increases percent or more in the preceding calendar year, the manufacturer of the prescription drug must file a report with the commissioner within calendar days of the date on which the or percent increase in cost occurs. This requirement is applicable to all manufacturers that manufactured prescription drugs that are sold to a person in this state on or after January 1, 2020. The report must include the information detailed in the bill. Certain information provided by a manufacturer, as detailed in the bill, is considered a confidential record and is required to be protected as a trade secret. Within calendar days of receipt, the commissioner is required to publish the nonconfidential information on the same publicly accessible internet site on which the manufacturer’s annual report information is published. The bill requires each health carrier to submit an annual report by February to the commissioner that contains information as detailed in the bill across all of the health carrier’s health benefit plans. This requirement is applicable to all health benefit plans providing for third-party payment or prepayment of health or medical expenses that provide a prescription drug benefit that have been delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2020. “Health carrier” is defined in the bill as an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to Code chapter 509A for public employees, or any other entity providing a plan of health insurance, health care benefits, or health care services. Certain information provided by a health carrier, as detailed in the bill, is considered a confidential record and must be protected as a trade secret. Prior to May of each year, the commissioner must publish the nonconfidential data received by the commissioner on the same publicly accessible internet site on which the manufacturers’ information is published. The data must be aggregated from the annual reports submitted by all health carriers. The bill directs the commissioner to adopt rules as necessary to administer the requirements outlined in the bill and allows the commissioner to take any action within the commissioner’s authority to enforce compliance with the manufacturer and health carrier reporting requirements outlined in the bill. The bill also requires a carrier to include all cost-sharing amounts paid by an enrollee of a health plan, or by another person on behalf of an enrollee, as part of the carrier’s calculation of an enrollee’s contribution to the enrollee’s applicable cost-sharing requirement. “Cost-sharing requirement” is defined in the bill as any copayment, coinsurance, deductible, or other out-of-pocket expense obligation required of or on behalf of an enrollee in order for the enrollee to receive a specific health care service, including a prescription drug, covered by the enrollee’s health plan. This requirement applies to all health plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021. The bill excludes state-regulated high-deductible health plans (HDHP) from the requirement if it will result in the plan not qualifying as an HDHP under section 223 of the Internal Revenue Code. The bill also prohibits application of the requirement to a carrier or a circumstance in a manner that will conflict with a federal law or a federal regulation.