Illinois General Assembly - Full Text of HB4595
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Full Text of HB4595  102nd General Assembly

HB4595ham001 102ND GENERAL ASSEMBLY

Rep. Greg Harris

Filed: 2/28/2022

 

 


 

 


 
10200HB4595ham001LRB102 23475 BMS 37106 a

1
AMENDMENT TO HOUSE BILL 4595

2    AMENDMENT NO. ______. Amend House Bill 4595 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Sections 424 and 513b1 as follows:
 
6    (215 ILCS 5/424)  (from Ch. 73, par. 1031)
7    Sec. 424. Unfair methods of competition and unfair or
8deceptive acts or practices defined. The following are hereby
9defined as unfair methods of competition and unfair and
10deceptive acts or practices in the business of insurance:
11        (1) The commission by any person of any one or more of
12    the acts defined or prohibited by Sections 134, 143.24c,
13    147, 148, 149, 151, 155.22, 155.22a, 155.42, 236, 237,
14    364, and 469, and 513b1 of this Code.
15        (2) Entering into any agreement to commit, or by any
16    concerted action committing, any act of boycott, coercion

 

 

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1    or intimidation resulting in or tending to result in
2    unreasonable restraint of, or monopoly in, the business of
3    insurance.
4        (3) Making or permitting, in the case of insurance of
5    the types enumerated in Classes 1, 2, and 3 of Section 4,
6    any unfair discrimination between individuals or risks of
7    the same class or of essentially the same hazard and
8    expense element because of the race, color, religion, or
9    national origin of such insurance risks or applicants. The
10    application of this Article to the types of insurance
11    enumerated in Class 1 of Section 4 shall in no way limit,
12    reduce, or impair the protections and remedies already
13    provided for by Sections 236 and 364 of this Code or any
14    other provision of this Code.
15        (4) Engaging in any of the acts or practices defined
16    in or prohibited by Sections 154.5 through 154.8 of this
17    Code.
18        (5) Making or charging any rate for insurance against
19    losses arising from the use or ownership of a motor
20    vehicle which requires a higher premium of any person by
21    reason of his physical disability, race, color, religion,
22    or national origin.
23        (6) Failing to meet any requirement of the Unclaimed
24    Life Insurance Benefits Act with such frequency as to
25    constitute a general business practice.
26(Source: P.A. 99-143, eff. 7-27-15; 99-893, eff. 1-1-17.)
 

 

 

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1    (215 ILCS 5/513b1)
2    Sec. 513b1. Pharmacy benefit manager contracts.
3    (a) As used in this Section:
4    "340B drug discount program" means the program established
5under Section 340B of the federal Public Health Service Act,
642 U.S.C. 256b.
7    "340B entity" means a covered entity as defined in 42
8U.S.C. 256b(a)(4) authorized to participate in the 340B drug
9discount program.
10    "340B pharmacy" means any pharmacy used to dispense 340B
11drugs for a covered entity, whether entity-owned or external.
12    "Biological product" has the meaning ascribed to that term
13in Section 19.5 of the Pharmacy Practice Act.
14    "Maximum allowable cost" means the maximum amount that a
15pharmacy benefit manager will reimburse a pharmacy for the
16cost of a drug.
17    "Maximum allowable cost list" means a list of drugs for
18which a maximum allowable cost has been established by a
19pharmacy benefit manager.
20    "Pharmacy benefit manager" means a person, business, or
21entity, including a wholly or partially owned or controlled
22subsidiary of a pharmacy benefit manager, that provides claims
23processing services or other prescription drug or device
24services, or both, for health benefit plans.
25    "Retail price" means the price an individual without

 

 

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1prescription drug coverage would pay at a retail pharmacy, not
2including a pharmacist dispensing fee.
3    "Third-party payer" means any entity that pays for
4prescription drugs on behalf of a patient other than a health
5care provider or sponsor of a plan subject to regulation under
6Medicare Part D, 42 U.S.C. 1395w–101, et seq.
7    (b) A contract between a health insurer and a pharmacy
8benefit manager must require that the pharmacy benefit
9manager:
10        (1) Update maximum allowable cost pricing information
11    at least every 7 calendar days.
12        (2) Maintain a process that will, in a timely manner,
13    eliminate drugs from maximum allowable cost lists or
14    modify drug prices to remain consistent with changes in
15    pricing data used in formulating maximum allowable cost
16    prices and product availability.
17        (3) Provide access to its maximum allowable cost list
18    to each pharmacy or pharmacy services administrative
19    organization subject to the maximum allowable cost list.
20    Access may include a real-time pharmacy website portal to
21    be able to view the maximum allowable cost list. As used in
22    this Section, "pharmacy services administrative
23    organization" means an entity operating within the State
24    that contracts with independent pharmacies to conduct
25    business on their behalf with third-party payers. A
26    pharmacy services administrative organization may provide

 

 

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1    administrative services to pharmacies and negotiate and
2    enter into contracts with third-party payers or pharmacy
3    benefit managers on behalf of pharmacies.
4        (4) Provide a process by which a contracted pharmacy
5    can appeal the provider's reimbursement for a drug subject
6    to maximum allowable cost pricing. The appeals process
7    must, at a minimum, include the following:
8            (A) A requirement that a contracted pharmacy has
9        14 calendar days after the applicable fill date to
10        appeal a maximum allowable cost if the reimbursement
11        for the drug is less than the net amount that the
12        network provider paid to the supplier of the drug.
13            (B) A requirement that a pharmacy benefit manager
14        must respond to a challenge within 14 calendar days of
15        the contracted pharmacy making the claim for which the
16        appeal has been submitted.
17            (C) A telephone number and e-mail address or
18        website to network providers, at which the provider
19        can contact the pharmacy benefit manager to process
20        and submit an appeal.
21            (D) A requirement that, if an appeal is denied,
22        the pharmacy benefit manager must provide the reason
23        for the denial and the name and the national drug code
24        number from national or regional wholesalers.
25            (E) A requirement that, if an appeal is sustained,
26        the pharmacy benefit manager must make an adjustment

 

 

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1        in the drug price effective the date the challenge is
2        resolved and make the adjustment applicable to all
3        similarly situated network pharmacy providers, as
4        determined by the managed care organization or
5        pharmacy benefit manager.
6        (5) Allow a plan sponsor contracting with a pharmacy
7    benefit manager an annual right to audit compliance with
8    the terms of the contract by the pharmacy benefit manager,
9    including, but not limited to, full disclosure of any and
10    all rebate amounts secured, whether product specific or
11    generalized rebates, that were provided to the pharmacy
12    benefit manager by a pharmaceutical manufacturer.
13        (6) Allow a plan sponsor contracting with a pharmacy
14    benefit manager to request that the pharmacy benefit
15    manager disclose the actual amounts paid by the pharmacy
16    benefit manager to the pharmacy.
17        (7) Provide notice to the party contracting with the
18    pharmacy benefit manager of any consideration that the
19    pharmacy benefit manager receives from the manufacturer
20    for dispense as written prescriptions once a generic or
21    biologically similar product becomes available.
22    (c) In order to place a particular prescription drug on a
23maximum allowable cost list, the pharmacy benefit manager
24must, at a minimum, ensure that:
25        (1) if the drug is a generically equivalent drug, it
26    is listed as therapeutically equivalent and

 

 

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1    pharmaceutically equivalent "A" or "B" rated in the United
2    States Food and Drug Administration's most recent version
3    of the "Orange Book" or have an NR or NA rating by
4    Medi-Span, Gold Standard, or a similar rating by a
5    nationally recognized reference;
6        (2) the drug is available for purchase by each
7    pharmacy in the State from national or regional
8    wholesalers operating in Illinois; and
9        (3) the drug is not obsolete.
10    (d) A pharmacy benefit manager is prohibited from limiting
11a pharmacist's ability to disclose whether the cost-sharing
12obligation exceeds the retail price for a covered prescription
13drug, and the availability of a more affordable alternative
14drug, if one is available in accordance with Section 42 of the
15Pharmacy Practice Act.
16    (e) A health insurer or pharmacy benefit manager shall not
17require an insured to make a payment for a prescription drug at
18the point of sale in an amount that exceeds the lesser of:
19        (1) the applicable cost-sharing amount; or
20        (2) the retail price of the drug in the absence of
21    prescription drug coverage.
22    (f) Unless required by law, a contract between a pharmacy
23benefit manager or third-party payer and a 340B entity or 340B
24pharmacy shall not contain any provision that:
25        (1) distinguishes between drugs purchased through the
26    340B drug discount program and other drugs when

 

 

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1    determining reimbursement or reimbursement methodologies,
2    or contains otherwise less favorable payment terms or
3    reimbursement methodologies for 340B entities or 340B
4    pharmacies when compared to similarly situated non-340B
5    entities;
6        (2) imposes any fee, chargeback, or rate adjustment
7    that is not similarly imposed on similarly situated
8    pharmacies that are not 340B entities or 340B pharmacies;
9        (3) imposes any fee, chargeback, or rate adjustment
10    that exceeds the fee, chargeback, or rate adjustment that
11    is not similarly imposed on similarly situated pharmacies
12    that are not 340B entities or 340B pharmacies;
13        (4) prevents or interferes with an individual's choice
14    to receive a covered prescription drug from a 340B entity
15    or 340B pharmacy through any legally permissible means,
16    except that nothing in this paragraph shall prohibit the
17    establishment of differing copayments or other
18    cost-sharing amounts within the benefit plan for covered
19    persons who acquire covered prescription drugs from a
20    nonpreferred or nonparticipating provider;
21        (5) excludes a 340B entity or 340B pharmacy from a
22    pharmacy network on any basis that includes consideration
23    of whether the 340B entity or 340B pharmacy participates
24    in the 340B drug discount program;
25        (6) prevents a 340B entity or 340B pharmacy from using
26    a drug purchased under the 340B drug discount program; or

 

 

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1        (7) any other provision that discriminates against a
2    340B entity or 340B pharmacy by treating the 340B entity
3    or 340B pharmacy differently than non-340B entities or
4    non-340B pharmacies for any reason relating to the
5    entity's participation in the 340B drug discount program.
6    As used in this subsection, "pharmacy benefit manager" and
7"third-party payer" do not include pharmacy benefit managers
8and third-party payers acting on behalf of a Medicaid program.
9    (g) A violation of this Section by a pharmacy benefit
10manager constitutes an unfair or deceptive act or practice in
11the business of insurance under Section 424.
12    (h) A provision that violates subsection (f) in a contract
13between a pharmacy benefit manager or a third-party payer and
14a 340B entity that is entered into, amended, or renewed after
15July 1, 2022 shall be void and unenforceable.
16    (i) (f) This Section applies to contracts entered into or
17renewed on or after July 1, 2022 2020.
18    (j) (g) This Section applies to any group or individual
19policy of accident and health insurance or managed care plan
20that provides coverage for prescription drugs and that is
21amended, delivered, issued, or renewed on or after July 1,
222020.
23(Source: P.A. 101-452, eff. 1-1-20.)
 
24    Section 10. The Illinois Public Aid Code is amended by
25changing Sections 5-5.12 and 5-36 as follows:
 

 

 

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1    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
2    Sec. 5-5.12. Pharmacy payments.
3    (a) Every request submitted by a pharmacy for
4reimbursement under this Article for prescription drugs
5provided to a recipient of aid under this Article shall
6include the name of the prescriber or an acceptable
7identification number as established by the Department.
8    (b) Pharmacies providing prescription drugs under this
9Article shall be reimbursed at a rate which shall include a
10professional dispensing fee as determined by the Illinois
11Department, plus the current acquisition cost of the
12prescription drug dispensed. The Illinois Department shall
13update its information on the acquisition costs of all
14prescription drugs no less frequently than every 30 days.
15However, the Illinois Department may set the rate of
16reimbursement for the acquisition cost, by rule, at a
17percentage of the current average wholesale acquisition cost.
18    (c) (Blank).
19    (d) The Department shall review utilization of narcotic
20medications in the medical assistance program and impose
21utilization controls that protect against abuse.
22    (e) When making determinations as to which drugs shall be
23on a prior approval list, the Department shall include as part
24of the analysis for this determination, the degree to which a
25drug may affect individuals in different ways based on factors

 

 

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1including the gender of the person taking the medication.
2    (f) The Department shall cooperate with the Department of
3Public Health and the Department of Human Services Division of
4Mental Health in identifying psychotropic medications that,
5when given in a particular form, manner, duration, or
6frequency (including "as needed") in a dosage, or in
7conjunction with other psychotropic medications to a nursing
8home resident or to a resident of a facility licensed under the
9ID/DD Community Care Act or the MC/DD Act, may constitute a
10chemical restraint or an "unnecessary drug" as defined by the
11Nursing Home Care Act or Titles XVIII and XIX of the Social
12Security Act and the implementing rules and regulations. The
13Department shall require prior approval for any such
14medication prescribed for a nursing home resident or to a
15resident of a facility licensed under the ID/DD Community Care
16Act or the MC/DD Act, that appears to be a chemical restraint
17or an unnecessary drug. The Department shall consult with the
18Department of Human Services Division of Mental Health in
19developing a protocol and criteria for deciding whether to
20grant such prior approval.
21    (g) The Department may by rule provide for reimbursement
22of the dispensing of a 90-day supply of a generic or brand
23name, non-narcotic maintenance medication in circumstances
24where it is cost effective.
25    (g-5) On and after July 1, 2012, the Department may
26require the dispensing of drugs to nursing home residents be

 

 

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1in a 7-day supply or other amount less than a 31-day supply.
2The Department shall pay only one dispensing fee per 31-day
3supply.
4    (h) Effective July 1, 2011, the Department shall
5discontinue coverage of select over-the-counter drugs,
6including analgesics and cough and cold and allergy
7medications.
8    (h-5) On and after July 1, 2012, the Department shall
9impose utilization controls, including, but not limited to,
10prior approval on specialty drugs, oncolytic drugs, drugs for
11the treatment of HIV or AIDS, immunosuppressant drugs, and
12biological products in order to maximize savings on these
13drugs. The Department may adjust payment methodologies for
14non-pharmacy billed drugs in order to incentivize the
15selection of lower-cost drugs. For drugs for the treatment of
16AIDS, the Department shall take into consideration the
17potential for non-adherence by certain populations, and shall
18develop protocols with organizations or providers primarily
19serving those with HIV/AIDS, as long as such measures intend
20to maintain cost neutrality with other utilization management
21controls such as prior approval. For hemophilia, the
22Department shall develop a program of utilization review and
23control which may include, in the discretion of the
24Department, prior approvals. The Department may impose special
25standards on providers that dispense blood factors which shall
26include, in the discretion of the Department, staff training

 

 

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1and education; patient outreach and education; case
2management; in-home patient assessments; assay management;
3maintenance of stock; emergency dispensing timeframes; data
4collection and reporting; dispensing of supplies related to
5blood factor infusions; cold chain management and packaging
6practices; care coordination; product recalls; and emergency
7clinical consultation. The Department may require patients to
8receive a comprehensive examination annually at an appropriate
9provider in order to be eligible to continue to receive blood
10factor.
11    (i) On and after July 1, 2012, the Department shall reduce
12any rate of reimbursement for services or other payments or
13alter any methodologies authorized by this Code to reduce any
14rate of reimbursement for services or other payments in
15accordance with Section 5-5e.
16    (j) On and after July 1, 2012, the Department shall impose
17limitations on prescription drugs such that the Department
18shall not provide reimbursement for more than 4 prescriptions,
19including 3 brand name prescriptions, for distinct drugs in a
2030-day period, unless prior approval is received for all
21prescriptions in excess of the 4-prescription limit. Drugs in
22the following therapeutic classes shall not be subject to
23prior approval as a result of the 4-prescription limit:
24immunosuppressant drugs, oncolytic drugs, anti-retroviral
25drugs, and, on or after July 1, 2014, antipsychotic drugs. On
26or after July 1, 2014, the Department may exempt children with

 

 

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1complex medical needs enrolled in a care coordination entity
2contracted with the Department to solely coordinate care for
3such children, if the Department determines that the entity
4has a comprehensive drug reconciliation program.
5    (k) No medication therapy management program implemented
6by the Department shall be contrary to the provisions of the
7Pharmacy Practice Act.
8    (l) Any provider enrolled with the Department that bills
9the Department for outpatient drugs and is eligible to enroll
10in the federal Drug Pricing Program under Section 340B of the
11federal Public Health Service Act shall enroll in that
12program. No entity participating in the federal Drug Pricing
13Program under Section 340B of the federal Public Health
14Service Act may exclude fee-for-service Medicaid from their
15participation in that program, however, although the
16Department may exclude entities defined in Section
171905(l)(2)(B) of the Social Security Act are excluded from
18this requirement. This subsection does not apply to outpatient
19drugs billed to Medicaid managed care organizations.
20(Source: P.A. 102-558, eff. 8-20-21.)
 
21    (305 ILCS 5/5-36)
22    Sec. 5-36. Pharmacy benefits.
23    (a)(1) The Department may enter into a contract with a
24third party on a fee-for-service reimbursement model for the
25purpose of administering pharmacy benefits as provided in this

 

 

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1Section for members not enrolled in a Medicaid managed care
2organization; however, these services shall be approved by the
3Department. The Department shall ensure coordination of care
4between the third-party administrator and managed care
5organizations as a consideration in any contracts established
6in accordance with this Section. Any managed care techniques,
7principles, or administration of benefits utilized in
8accordance with this subsection shall comply with State law.
9    (2) The following shall apply to contracts between
10entities contracting relating to the Department's third-party
11administrators and pharmacies:
12        (A) the Department shall approve any contract between
13    a third-party administrator and a pharmacy;
14        (B) the Department's third-party administrator shall
15    not change the terms of a contract between a third-party
16    administrator and a pharmacy without written approval by
17    the Department; and
18        (C) the Department's third-party administrator shall
19    not create, modify, implement, or indirectly establish any
20    fee on a pharmacy, pharmacist, or a recipient of medical
21    assistance without written approval by the Department.
22    (b) The provisions of this Section shall not apply to
23outpatient pharmacy services provided by a health care
24facility registered as a covered entity pursuant to 42 U.S.C.
25256b or any pharmacy owned by or contracted with the covered
26entity. A Medicaid managed care organization shall, either

 

 

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1directly or through a pharmacy benefit manager, administer and
2reimburse outpatient pharmacy claims submitted by a health
3care facility registered as a covered entity pursuant to 42
4U.S.C. 256b, its owned pharmacies, and contracted pharmacies
5in accordance with the contractual agreements the Medicaid
6managed care organization or its pharmacy benefit manager has
7with such facilities and pharmacies and in accordance with
8subsection (h-5).
9    (b-5) Any pharmacy benefit manager that contracts with a
10Medicaid managed care organization to administer and reimburse
11pharmacy claims as provided in this Section must be registered
12with the Director of Insurance in accordance with Section
13513b2 of the Illinois Insurance Code.
14    (c) On at least an annual basis, the Director of the
15Department of Healthcare and Family Services shall submit a
16report beginning no later than one year after January 1, 2020
17(the effective date of Public Act 101-452) that provides an
18update on any contract, contract issues, formulary, dispensing
19fees, and maximum allowable cost concerns regarding a
20third-party administrator and managed care. The requirement
21for reporting to the General Assembly shall be satisfied by
22filing copies of the report with the Speaker, the Minority
23Leader, and the Clerk of the House of Representatives and with
24the President, the Minority Leader, and the Secretary of the
25Senate. The Department shall take care that no proprietary
26information is included in the report required under this

 

 

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1Section.
2    (d) A pharmacy benefit manager shall notify the Department
3in writing of any activity, policy, or practice of the
4pharmacy benefit manager that directly or indirectly presents
5a conflict of interest that interferes with the discharge of
6the pharmacy benefit manager's duty to a managed care
7organization to exercise its contractual duties. "Conflict of
8interest" shall be defined by rule by the Department.
9    (e) A pharmacy benefit manager shall, upon request,
10disclose to the Department the following information:
11        (1) whether the pharmacy benefit manager has a
12    contract, agreement, or other arrangement with a
13    pharmaceutical manufacturer to exclusively dispense or
14    provide a drug to a managed care organization's enrollees,
15    and the aggregate amounts of consideration of economic
16    benefits collected or received pursuant to that
17    arrangement;
18        (2) the percentage of claims payments made by the
19    pharmacy benefit manager to pharmacies owned, managed, or
20    controlled by the pharmacy benefit manager or any of the
21    pharmacy benefit manager's management companies, parent
22    companies, subsidiary companies, or jointly held
23    companies;
24        (3) the aggregate amount of the fees or assessments
25    imposed on, or collected from, pharmacy providers; and
26        (4) the average annualized percentage of revenue

 

 

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1    collected by the pharmacy benefit manager as a result of
2    each contract it has executed with a managed care
3    organization contracted by the Department to provide
4    medical assistance benefits which is not paid by the
5    pharmacy benefit manager to pharmacy providers and
6    pharmaceutical manufacturers or labelers or in order to
7    perform administrative functions pursuant to its contracts
8    with managed care organizations.
9    (f) The information disclosed under subsection (e) shall
10include all retail, mail order, specialty, and compounded
11prescription products. All information made available to the
12Department under subsection (e) is confidential and not
13subject to disclosure under the Freedom of Information Act.
14All information made available to the Department under
15subsection (e) shall not be reported or distributed in any way
16that compromises its competitive, proprietary, or financial
17value. The information shall only be used by the Department to
18assess the contract, agreement, or other arrangements made
19between a pharmacy benefit manager and a pharmacy provider,
20pharmaceutical manufacturer or labeler, managed care
21organization, or other entity, as applicable.
22    (g) A pharmacy benefit manager shall disclose directly in
23writing to a pharmacy provider or pharmacy services
24administrative organization contracting with the pharmacy
25benefit manager of any material change to a contract provision
26that affects the terms of the reimbursement, the process for

 

 

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1verifying benefits and eligibility, dispute resolution,
2procedures for verifying drugs included on the formulary, and
3contract termination at least 30 days prior to the date of the
4change to the provision. The terms of this subsection shall be
5deemed met if the pharmacy benefit manager posts the
6information on a website, viewable by the public. A pharmacy
7service administration organization shall notify all contract
8pharmacies of any material change, as described in this
9subsection, within 2 days of notification. As used in this
10Section, "pharmacy services administrative organization" means
11an entity operating within the State that contracts with
12independent pharmacies to conduct business on their behalf
13with third-party payers. A pharmacy services administrative
14organization may provide administrative services to pharmacies
15and negotiate and enter into contracts with third-party payers
16or pharmacy benefit managers on behalf of pharmacies.
17    (h) A pharmacy benefit manager shall not include the
18following in a contract with a pharmacy provider:
19        (1) a provision prohibiting the provider from
20    informing a patient of a less costly alternative to a
21    prescribed medication; or
22        (2) a provision that prohibits the provider from
23    dispensing a particular amount of a prescribed medication,
24    if the pharmacy benefit manager allows that amount to be
25    dispensed through a pharmacy owned or controlled by the
26    pharmacy benefit manager, unless the prescription drug is

 

 

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1    subject to restricted distribution by the United States
2    Food and Drug Administration or requires special handling,
3    provider coordination, or patient education that cannot be
4    provided by a retail pharmacy.
5    (h-5) Unless required by law, a Medicaid managed care
6organization or pharmacy benefit manager administering or
7managing benefits on behalf of a Medicaid managed care
8organization shall not refuse to contract with a 340B entity
9or 340B pharmacy for refusing to accept less favorable payment
10terms or reimbursement methodologies when compared to
11similarly situated non-340B entities and shall not include in
12a contract with a 340B entity or 340B pharmacy a provision
13that:
14        (1) imposes any fee, chargeback, or rate adjustment
15    that is not similarly imposed on similarly situated
16    pharmacies that are not 340B entities or 340B pharmacies;
17        (2) imposes any fee, chargeback, or rate adjustment
18    that exceeds the fee, chargeback, or rate adjustment that
19    is not similarly imposed on similarly situated pharmacies
20    that are not 340B entities or 340B pharmacies;
21        (3) prevents or interferes with an individual's choice
22    to receive a prescription drug from a 340B entity or 340B
23    pharmacy through any legally permissible means;
24        (4) excludes a 340B entity or 340B pharmacy from a
25    pharmacy network on the basis of whether the 340B entity
26    or 340B pharmacy participates in the 340B drug discount

 

 

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1    program;
2        (5) prevents a 340B entity or 340B pharmacy from using
3    a drug purchased under the 340B drug discount program so
4    long as the drug recipient is a patient of the 340B entity;
5    nothing in this Section exempts a 340B pharmacy from
6    following the Department's preferred drug list or from any
7    prior approval requirements of the Department or the
8    Medicaid managed care organization that are imposed on the
9    drug for all pharmacies; or
10        (6) any other provision that discriminates against a
11    340B entity or 340B pharmacy by treating a 340B entity or
12    340B pharmacy differently than non-340B entities or
13    non-340B pharmacies for any reason relating to the
14    entity's participation in the 340B drug discount program.
15    A provision that violates this subsection in any contract
16between a Medicaid managed care organization or its pharmacy
17benefit manager and a 340B entity entered into, amended, or
18renewed after July 1, 2022 shall be void and unenforceable.
19    In this subsection (h-5):
20    "340B entity" means a covered entity as defined in 42
21U.S.C. 256b(a)(4) authorized to participate in the 340B drug
22discount program.
23    "340B pharmacy" means any pharmacy used to dispense 340B
24drugs for a covered entity, whether entity-owned or external.
25    (i) Nothing in this Section shall be construed to prohibit
26a pharmacy benefit manager from requiring the same

 

 

10200HB4595ham001- 22 -LRB102 23475 BMS 37106 a

1reimbursement and terms and conditions for a pharmacy provider
2as for a pharmacy owned, controlled, or otherwise associated
3with the pharmacy benefit manager.
4    (j) A pharmacy benefit manager shall establish and
5implement a process for the resolution of disputes arising out
6of this Section, which shall be approved by the Department.
7    (k) The Department shall adopt rules establishing
8reasonable dispensing fees for fee-for-service payments in
9accordance with guidance or guidelines from the federal
10Centers for Medicare and Medicaid Services.
11(Source: P.A. 101-452, eff. 1-1-20; 102-558, eff. 8-20-21.)
 
12    Section 99. Effective date. This Act takes effect July 1,
132022.".