Vote Smart's Synopsis:

Vote to pass a bill that amends certain prescription drug cost laws.

Highlights:

• Defines “Cost-sharing” as the cost to an individual insured under a health benefit plan according to any of the following, including, but not limited to (Sec. 1):

• Coverage limit or copayment;

• Coinsurance or deductible; or

• Any other out-of-pocket expense requirements imposed by the plan.

• Prohibits a health plan issuer, pharmacy benefit manager, or any other administrator to require cost-sharing in an amount that exceeds either of the following, including, but not limited to (Sec. 1):

• The amount an individual would pay for a drug purchased without coverage under a health benefit plan; and

• The net reimbursement paid to the pharmacy for the prescription drug by the health plan issuer, pharmacy benefit manager,or administrator.

• Prohibits a health plan issuer, pharmacy benefit manager, or administrator from retroactively adjusting a pharmacy claim for reimbursement for a prescription drug, unless under the following conditions, including, but not limited to (Sec. 1):

• A pharmacy audit; or

• A technical billing error.

• Specifies that a health plan issuer, pharmacy benefit manager, or administrator from charging a fee related to a claim unless the amount of the fee can be determined at the time of claim adjudication (Sec. 1).

• Specifies that the Department of Insurance will create a web form that consumers can use to submit complaints related to violations under this act (Sec. 1).

• Requires a pharmacist, pharmacy intern, or terminal distributor of dangerous drugs who has information indicating that the cost-sharing amount charged by an individual patient's health benefit plan exceeds the amount that may otherwise be charged to notify the individual patient about this information and not charge a higher amount (Sec. 1).

Full Bill Text