Alaska 2023-2024 Regular Session

Alaska Senate Bill SB124 Compare Versions

Only one version of the bill is available at this time.

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2	2	SB0124A -1- SB 124
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11	11	SENATE BILL NO. 124
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13	13	IN THE LEGISLATURE OF THE STATE OF ALASKA
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15	15	THIRTY-THIRD LEGISLATURE - FIRST SESSION
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17	17	BY SENATOR WILSON BY REQUEST
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19	19	Introduced: 4/5/23
20	20	Referred:
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22	22
23	23	A BILL
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25	25	FOR AN ACT ENTITLED
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27	27	"An Act relating to health care insurers; relating to pharmacy benefits managers; 1
28	28	relating to prescription drug defined cost sharing; and providing for an effective date." 2
29	29	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 3
30	30	* Section 1. AS 21.27.955 is amended to read: 4
31	31	Sec. 21.27.955. Definitions. In AS 21.27.901 - 21.27.960 [AS 21.27.901 -
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33	33	21.27.955], 6
34	34	(1) "audit" means an official examination and verification of accounts 7
35	35	and records; 8
36	36	(2) "claim" means a request from a pharmacy or pharmacist to be 9
37	37	reimbursed for the cost of filling or refilling a prescription for a drug or for providing 10
38	38	a medical supply or device; 11
39	39	(3) "defined cost sharing" has the meaning given in AS 21.42.599; 12
40	40	(4) [(3)] "extrapolation" means the practice of inferring a frequency or 13
41	41	dollar amount of overpayments, underpayments, invalid claims, or other errors on any 14 33-LS0304\U
42	42	SB 124 -2- SB0124A
43	43	New Text Underlined [DELETED TEXT BRACKETED]
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45	45	portion of claims submitted, based on the frequency or dollar amount of 1
46	46	overpayments, underpayments, invalid claims, or other errors actually measured in a 2
47	47	sample of claims; 3
48	48	(5) "health care insurer" means 4
49	49	(A) an insurer regulated by this title that offers health 5
50	50	insurance coverage as defined in 42 U.S.C. 300gg-91; or 6
51	51	(B) a state or local governmental plan; 7
52	52	(6) [(4)] "list" means the list of multi-source generic drugs for which a 8
53	53	predetermined reimbursement amount has been established such as a maximum 9
54	54	allowable cost or maximum allowable cost list or any other list of prices used by a 10
55	55	pharmacy benefits manager; 11
56	56	(7) [(5)] "multi-source generic drug" means any covered outpatient 12
57	57	prescription drug that the United States Food and Drug Administration has determined 13
58	58	is pharmaceutically equivalent or bioequivalent to the originator or name brand drug 14
59	59	and for which there are at least two drug products that are rated as therapeutically 15
60	60	equivalent under the United States Food and Drug Administration's most recent 16
61	61	publication of "Approved Drug Products with Therapeutic Equivalence Evaluations"; 17
62	62	(8) [(6)] "network pharmacy" means a pharmacy that provides covered 18
63	63	health care services or supplies to an insured or a member under a contract with a 19
64	64	network plan to act as a participating provider; 20
65	65	(9) [(7)] "pharmacy" has the meaning given in AS 08.80.480; 21
66	66	(10) [(8)] "pharmacy acquisition cost" means the amount that a 22
67	67	pharmaceutical wholesaler or distributor charges for a pharmaceutical product as listed 23
68	68	on the pharmacy's invoice; 24
69	69	(11) [(9)] "pharmacy benefits manager" means a person that 25
70	70	(A) contracts with a pharmacy on behalf of a health care [AN] 26
71	71	insurer to process claims or pay pharmacies for prescription drugs or medical 27
72	72	devices and supplies or provide network management for pharmacies; or 28
73	73	(B) contracts with or is employed by a health care insurer, 29
74	74	either directly or through an intermediary, to manage a prescription drug 30
75	75	benefit provided by the health care insurer, including the processing and 31 33-LS0304\U
76	76	SB0124A -3- SB 124
77	77	New Text Underlined [DELETED TEXT BRACKETED]
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79	79	payment of claims for prescription drugs, performance of prescription 1
80	80	drug utilization review, processing of drug prior authorization requests, 2
81	81	adjudication of appeals or grievances related to the prescription drug 3
82	82	benefit, contracting with network pharmacies, or otherwise controlling the 4
83	83	cost of prescription drugs; 5
84	84	(12) "rebate" has the meaning given in AS 21.42.599; 6
85	85	(13) [(10)] "recoupment" means the amount that a pharmacy must 7
86	86	remit to a pharmacy benefits manager when the pharmacy benefits manager has 8
87	87	determined that an overpayment to the pharmacy has occurred. 9
88	88	* Sec. 2. AS 21.27 is amended by adding a new section to article 9 to read: 10
89	89	Sec. 21.27.960. Defined cost sharing and prescription drugs. (a) A 11
90	90	pharmacy benefits manager and agents of a pharmacy benefits manager shall ensure 12
91	91	that a covered person's defined cost sharing for a prescription drug is calculated at the 13
92	92	point of sale based on a price that is reduced by an amount equal to at least 85 percent 14
93	93	of all rebates received, or that will be received, in connection with the dispensing or 15
94	94	administration of the prescription drug. The pharmacy benefits manager or the agent 16
95	95	of the pharmacy benefits manager shall ensure that a good faith estimate of the 17
96	96	covered person's reduction in defined cost sharing required under this subsection is 18
97	97	passed through to the covered person at the point of sale. 19
98	98	(b) The director or a pharmacy benefits manager may not impose liability, a 20
99	99	penalty, or disciplinary action on a pharmacy or pharmacist for the pharmacy's or 21
100	100	pharmacist's failure to reduce a covered person's defined cost sharing under (a) of this 22
101	101	section if the covered person's health care insurer fails to provide the pharmacy or 23
102	102	pharmacist with the information necessary to calculate the reduction. The health care 24
103	103	insurer may not impose a monetary penalty on, or withhold a payment to, a pharmacy 25
104	104	or pharmacist that engaged in good faith efforts to comply with (a) of this section. 26
105	105	(c) Nothing in this section prevents a health care insurer or an agent of a 27
106	106	health care insurer from reducing a covered person's defined cost sharing by an 28
107	107	amount greater than the amount calculated under (a) of this section. 29
108	108	(d) A pharmacy benefits manager may not be required to disclose the amount 30
109	109	of rebates a health care insurer or pharmacy benefits manager receives on a product-31 33-LS0304\U
110	110	SB 124 -4- SB0124A
111	111	New Text Underlined [DELETED TEXT BRACKETED]
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113	113	specific, manufacturer-specific, or pharmacy-specific basis, except as required to 1
114	114	comply with this section. Information and records relating to the amount of rebates a 2
115	115	health insurer or pharmacy benefits manager receives on a product-specific, 3
116	116	manufacturer-specific, or pharmacy-specific basis are confidential for the purposes of 4
117	117	AS 21.06.060. 5
118	118	(e) If a provision in this section conflicts with federal law, the provision does 6
119	119	not apply to the extent of the conflict. 7
120	120	(f) The director may audit the books and records of a pharmacy benefits 8
121	121	manager registered under this chapter to determine whether the pharmacy benefits 9
122	122	manager has complied with the requirements of this section. 10
123	123	* Sec. 3. AS 21.42 is amended by adding a new section to read: 11
124	124	Sec. 21.42.435. Defined cost sharing and prescription drugs. (a) A health 12
125	125	care insurer and agents of a health care insurer shall ensure that a covered person's 13
126	126	defined cost sharing for a prescription drug is calculated at the point of sale based on a 14
127	127	price that is reduced by an amount equal to at least 85 percent of all rebates received, 15
128	128	or that will be received, in connection with the dispensing or administration of the 16
129	129	prescription drug. The health care insurer or the agent of the health care insurer shall 17
130	130	ensure that a good faith estimate of the covered person's reduction in defined cost 18
131	131	sharing required under this subsection is passed through to the covered person at the 19
132	132	point of sale. 20
133	133	(b) The director or a health care insurer may not impose liability, a penalty, or 21
134	134	disciplinary action on a pharmacy or pharmacist for the pharmacy's or pharmacist's 22
135	135	failure to reduce a covered person's defined cost sharing under (a) of this section if the 23
136	136	covered person's health care insurer fails to provide the pharmacy or pharmacist with 24
137	137	the information necessary to calculate the reduction. The health care insurer may not 25
138	138	impose a monetary penalty on, or withhold a payment to, a pharmacy or pharmacist 26
139	139	that engaged in good faith efforts to comply with (a) of this section. 27
140	140	(c) Nothing in this section prevents a health care insurer or an agent of a 28
141	141	health care insurer from reducing a covered person's defined cost sharing by an 29
142	142	amount greater than the amount calculated under (a) of this section. 30
143	143	(d) A health care insurer or an agent of a health care insurer may not be 31 33-LS0304\U
144	144	SB0124A -5- SB 124
145	145	New Text Underlined [DELETED TEXT BRACKETED]
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147	147	required to disclose the amount of rebates a health care insurer or pharmacy benefits 1
148	148	manager receives on a product-specific, manufacturer-specific, or pharmacy-specific 2
149	149	basis, except as required to comply with this section. Information and records relating 3
150	150	to the amount of rebates a health insurer or pharmacy benefits manager receives on a 4
151	151	product-specific, manufacturer-specific, or pharmacy-specific basis are confidential 5
152	152	for the purposes of AS 21.06.060. 6
153	153	(e) If a provision in this section conflicts with federal law, the provision does 7
154	154	not apply to the extent of the conflict. 8
155	155	(f) The director may audit the books and records of a health care insurer to 9
156	156	determine whether the health care insurer has complied with the requirements of this 10
157	157	section. 11
158	158	(g) In this section, "health care insurer" has the meaning given in 12
159	159	AS 21.27.955. 13
160	160	* Sec. 4. AS 21.42.599 is amended by adding new paragraphs to read: 14
161	161	(9) "defined cost sharing" means a deductible payment, coinsurance, or 15
162	162	similar amount owed by a covered person under the terms of the covered person's 16
163	163	health care insurance plan; 17
164	164	(10) "negotiated price concession" includes a base price concession or 18
165	165	reasonable estimate of any price protection rebate and performance-based price 19
166	166	concession that may accrue directly or indirectly to a health care insurer during the 20
167	167	coverage year from a manufacturer, dispensing pharmacy, or other party in connection 21
168	168	with the dispensing or administration of a prescription drug; 22
169	169	(11) "price protection rebate" means a negotiated price concession that 23
170	170	accrues directly or indirectly to the health care insurer, or another person on behalf of 24
171	171	the health care insurer, in the event of an increase in the wholesale acquisition cost of 25
172	172	a drug above a threshold specified in a contract to which the health care insurer, or 26
173	173	another person on behalf of the health care insurer, is a party; 27
174	174	(12) "rebate" means a 28
175	175	(A) negotiated price concession, whether or not the negotiated 29
176	176	price concession is described as a rebate or accrues directly or indirectly to a 30
177	177	health care insurer during the coverage year from a manufacturer, dispensing 31 33-LS0304\U
178	178	SB 124 -6- SB0124A
179	179	New Text Underlined [DELETED TEXT BRACKETED]
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181	181	pharmacy, or other party in connection with the dispensing or administration of 1
182	182	a prescription drug; or 2
183	183	(B) reasonable estimate of any negotiated price concessions, 3
184	184	fees, and other administrative costs that are passed through, or are reasonably 4
185	185	anticipated to be passed through, to the health care insurer and serve to reduce 5
186	186	the health care insurer's prescription drug liabilities. 6
187	187	* Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 7
188	188	read: 8
189	189	APPLICABILITY. This Act applies to an insurance policy or contract issued, 9
190	190	delivered, or renewed on or after the effective date of this Act. 10
191	191	* Sec. 6. This Act takes effect January 1, 2025. 11