Signed by Governor Tom Wolf

Vote Smart's Synopsis:

Vote to amend and pass a bill that prohibits price comparison "gag clauses" by pharmacy benefit managers.

Highlights:

• Authorizes a pharmacy or pharmacist to have the right to provide a covered individual with information concerning the cost of a prescription drug, including the individual’s cost share (Sec. 3).

• Prohibits a pharmacy, pharmacist or contracting agent of a pharmacy or pharmacist from being prohibited from or penalized by a pharmacy benefit manager or pharmacy services administration organization for discussing the information covered in the previous highlight, disclosing the availability of therapeutically equivalent alternative medications, or selling to the covered individual a more affordable alternative (Sec. 3).

• Defines “pharmacy benefit management” as any of the following (Sec. 2):

• Procurement of prescription drugs at a negotiated contracted rate for distribution within this state to covered individuals;

• Administration or management of prescription drug benefits provided by a covered entity for the benefit of covered individuals; and

• Administration of pharmacy benefits, including:

• Operating a mail-service pharmacy;

• Claims processing;

• Retail pharmacy network management;

• Paying claims to pharmacies for prescription drugs dispensed to covered individuals by a retail, specialty or mail-order pharmacy;

• Developing and managing a clinical formulary, utilization management and quality assurance programs;

• Rebate contracting and administration;

• Managing a patient compliance, therapeutic intervention and generic substitution program;

• Operating a disease management program; and

• Setting pharmacy reimbursement pricing and methodologies, including maximum allowable cost, and determining single or multiple source drugs.

Full Bill Text