Relating to pharmacy benefit managers and information related to the management of prescription drug benefits, and including applicability provisions. Effective 7-1-19

This bill relates to pharmacy benefit managers, health carriers, and the management of prescription drug benefits. The bill requires a pharmacy benefit manager to submit an annual report to the insurance commissioner that provides information on prescription drug prices and rebates received by the pharmacy benefit manager. The information is required to cover the prior calendar year and encompass prescription drug benefits provided to covered persons of each health carrier with whom the pharmacy benefit manager was contracted during that calendar year. “Pharmacy benefits manager” is defined in the bill as a person who, pursuant to a contract or an employment relationship with a health carrier, either directly or through an affiliate or intermediary, manages a prescription drug benefit provided by the health carrier. The bill defines a “health carrier” 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. The commissioner is required to make the information provided by the pharmacy benefit managers available on a publicly accessible internet site. The bill prohibits the pharmacy benefits manager or the commissioner from providing the information in a manner that identifies a specific health carrier, a specific price charged by a pharmaceutical manufacturer, or the amount of rebates received by a pharmacy benefit manager for a specific drug or class of drug. If information submitted to the commissioner by the pharmacy benefits manager does contain any of these details, the information is deemed confidential and proprietary and is a confidential record pursuant to Code chapter 22. The bill prohibits a health carrier from imposing a cost sharing requirement on a covered person for a prescription drug that exceeds an amount equal to the greater of either the dollar amount of percent or more of the aggregate rebates received by the health carrier, or an amount that ensures that the covered person’s cost sharing for the prescription drug shall not exceed percent of the health carrier’s cost for the prescription drug. “Covered person” is defined in the bill as a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. A health carrier is prohibited from disclosing any information regarding the actual amount of rebates the health carrier received for a specific drug, or from a specific pharmaceutical manufacturer, or from a specific pharmacy in order to comply with the cost sharing requirement. Rebate information is protected as a trade secret and is a confidential record. A health carrier is also required to have an agreement with the health carrier’s third-party vendors and downstream entities as necessary to ensure the information is protected as a trade secret. The bill requires the commissioner of insurance to adopt rules as necessary to administer the provisions of the bill. The bill also allows the commissioner to take any action within the commissioner’s authority to enforce compliance with the provisions of the bill. The bill is applicable to health benefit plans that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2020.