None by Governor Eric Holcomb

Vote Smart's Synopsis:

Vote to adopt a conference report vote and pass a bill that authorizes pharmacy benefits managers to negotiate prices for drugs and send reports about their costs.

Highlights:

• Requires that every 6 months, pharmacy benefit managers provide a report to the department (Sec. 1).

• Requires the report to include an overall total amount charged to a health plan for all pharmaceutical claims and an overall total of the amount paid to pharmacies for claims processed by the benefit manager (Sec. 1).

• Specifies that this chapter applies to health insurance coverage issued after December 31, 2024 (Sec. 2).

• Defines a ‘covered individual’ to mean an individual who is entitled to health insurance coverage (Sec. 2).

• Defines ‘defined cost sharing’ to mean a deductible payment or coinsurance amount imposed on a covered individual for a covered prescription drug under their insurance (Sec. 2).

• Defines ‘price protection rebate’ to mean a negotiated price concession that the insurer receives, or another party on their behalf, if there is an increase on the wholesale acquisition cost of a prescription drug above a specific threshold (Sec. 2).

• Defines ‘rebate’ to mean a discount that is anticipated to be passed through to an insurer from the manufacturer or pharmacy, and as a reasonable estimate of any negotiated price concession or fee to the insurer that serves to reduce the insurer’s liability for a prescription drug (Sec. 2).

• Requires that a covered individual’s define cost sharing for a prescription drug to be (Sec. 2):

• Calculated at the point of sale;

• Based on the price that is reduced by an amount equal to at least 85% of all rebates in connection with the dispensing of the drug.

• Authorizes the commissioner to take appropriate action to enforce chapters of this Act by imposing a civil penalty not exceeding $10,000 per violation (Sec. 2).

• Defines ‘plan sponsor’ to mean an employer or organization that offers health insurance coverage to its employees or members through an insurer (Sec. 3).

• Requires that an insurer passes on to the plan sponsor, 100% of all rebates concerning the dispensing and administration of prescription drugs to the covered individuals of the plan sponsor (Sec. 3).

• Requires that the insurer provide plan sponsors the option of calculating defined costs sharing for covered individuals based on a price reduced by some or all of the rebates received by the insurer concerning the dispensing of prescription drugs (Sec. 3).

• Requires that an insurer discloses the following information to a plan sponsor n an annual basis (Sec. 3):

• The amount of rebates expected to be received concerning the dispensing of prescription drugs;

• An explanation the plan sponsor may choose in order to apply the rebates to reduce premiums for covered individuals, and to calculator defined cost sharing for a covered individual based on a price reduced by rebates received by the insurer concerning dispensing prescription drugs;

• An explanation that, in the individual market, requires that the covered individual defined cost sharing be calculated at the point of sale based on a price that is reduced by at least 85% of the rebates concerning the dispensing of prescription drugs.

• Prohibits insurers from publishing the exact amount of rebates the insurer receives on a product and requires them to impose the confidentiality requirements on any vendor or third party that performs health care or administrative services on their behalf (Sec. 3).

Full Bill Text

Vote Smart's Synopsis:

Vote to adopt a conference report vote and pass a bill that authorizes pharmacy benefits managers to negotiate prices for drugs and send reports about their costs.

Highlights:

• Requires that every 6 months, pharmacy benefit managers provide a report to the department (Sec. 1).

• Requires the report to include an overall total amount charged to a health plan for all pharmaceutical claims and an overall total of the amount paid to pharmacies for claims processed by the benefit manager (Sec. 1).

• Specifies that this chapter applies to health insurance coverage issued after December 31, 2024 (Sec. 2).

• Defines a ‘covered individual’ to mean an individual who is entitled to health insurance coverage (Sec. 2).

• Defines ‘defined cost sharing’ to mean a deductible payment or coinsurance amount imposed on a covered individual for a covered prescription drug under their insurance (Sec. 2).

• Defines ‘price protection rebate’ to mean a negotiated price concession that the insurer receives, or another party on their behalf, if there is an increase on the wholesale acquisition cost of a prescription drug above a specific threshold (Sec. 2).

• Defines ‘rebate’ to mean a discount that is anticipated to be passed through to an insurer from the manufacturer or pharmacy, and as a reasonable estimate of any negotiated price concession or fee to the insurer that serves to reduce the insurer’s liability for a prescription drug (Sec. 2).

• Requires that a covered individual’s define cost sharing for a prescription drug to be (Sec. 2):

• Calculated at the point of sale;

• Based on the price that is reduced by an amount equal to at least 85% of all rebates in connection with the dispensing of the drug.

• Authorizes the commissioner to take appropriate action to enforce chapters of this Act by imposing a civil penalty not exceeding $10,000 per violation (Sec. 2).

• Defines ‘plan sponsor’ to mean an employer or organization that offers health insurance coverage to its employees or members through an insurer (Sec. 3).

• Requires that an insurer passes on to the plan sponsor, 100% of all rebates concerning the dispensing and administration of prescription drugs to the covered individuals of the plan sponsor (Sec. 3).

• Requires that the insurer provide plan sponsors the option of calculating defined costs sharing for covered individuals based on a price reduced by some or all of the rebates received by the insurer concerning the dispensing of prescription drugs (Sec. 3).

• Requires that an insurer discloses the following information to a plan sponsor n an annual basis (Sec. 3):

• The amount of rebates expected to be received concerning the dispensing of prescription drugs;

• An explanation the plan sponsor may choose in order to apply the rebates to reduce premiums for covered individuals, and to calculator defined cost sharing for a covered individual based on a price reduced by rebates received by the insurer concerning dispensing prescription drugs;

• An explanation that, in the individual market, requires that the covered individual defined cost sharing be calculated at the point of sale based on a price that is reduced by at least 85% of the rebates concerning the dispensing of prescription drugs.

• Prohibits insurers from publishing the exact amount of rebates the insurer receives on a product and requires them to impose the confidentiality requirements on any vendor or third party that performs health care or administrative services on their behalf (Sec. 3).

Full Bill Text