HCSHB198--INSURANCECOVERAGEOFPHARMACYSERVICES
SPONSOR: Wright
COMMITTEEACTION:Voted"DoPasswithHCS"bytheStanding
CommitteeonHealthandMentalHealthPolicybyavoteof11to2.
ThefollowingisasummaryoftheHouseCommitteeSubstituteforHB
198.
Thisbillestablishesrequirementsforinsurancecoverageof
certainpharmacyservices. Thisbillprovidesthatahealth
carrier,pharmacybenefitsmanager,oragentofsuchentitiesare
prohibitedfromimposinganypenalty,impediment,differentiation,
orlimitationon:
(1)Participatingprovidersforprovidingmedicallynecessary
clinician-administereddrugs,regardlessofwhetherthe
participatingproviderobtainssuchdrugsfromaproviderthatis
inthenetwork;
(2)Apersonwhoisadministeredmedicallynecessaryclinician
administereddrugsregardlessofwhethertheparticipatingprovider
obtainssuchdrugsfromaproviderthatisinthenetwork;or
(3)Anypharmacy,includinganyclassBhospitalpharmacyas
definedinSection338.220,RSMo,thatisdispensingmedically
necessaryclinician-administereddrugsregardlessofwhetherthe
participatingproviderobtainssuchdrugsfromaproviderthatis
inthenetwork.
Thisprohibitiondoesnotapplyiftheclinician-administereddrug
isnototherwisecoveredbythehealthcarrierorpharmacybenefits
manager.
Thisbillpreventshealthcarriers,pharmacybenefitsmanagers,or
agentsthereoffromdiscriminating againstacoveredentityor
pharmacybydoinganyofthefollowing:
(1)Reimbursingforaquantityofacertaindruginanamountless
thanitwouldpaytoasimilarlysituatedpharmacy,onthebasis
thatisspecifiedinthebill;
(2)Imposingtermsorconditionsoncoveredentitiesorpharmacies
thatdifferfromtermsandconditionsappliedtoothersimilarly
situatedpharmaciesorentitiesthatarenotcoveredentities,on
thebasisthatisspecifiedinthebill; (3)Interferingwithaperson'schoicetoreceiveacertaindrug
fromacoveredentityorpharmacy;
(4)Requiringacoveredentityorpharmacytoidentifycertain
drugs;
(5)Refusingtocontractwithacoveredentityorpharmacyfor
reasonsotherthanthosethatapplyequallytoentitiesthatare
notcoveredentitiesorsimilarlysituatedpharmacies,orona
certainbasis;
(6)Denyingthecoveredentitytheabilitytopurchasedrugsat
340Bprogrampricingbysubstitutingarebatediscount;
(7)Refusingtocoverdrugspurchasedunderthe340Bpricing
program;or
(8)Requiringacoveredentityorpharmacytoreverse,resubmit,
orclarifya340B-drugpricingclaimaftertheinitialadjudication
unlesstheseactionsareinthenormalcourseofapharmacy
business,andnotrelatedto340Bdrugpricing.
TheDirectoroftheDepartmentofCommerceandInsuranceshall
imposeacivilpenaltyonanyhealthcarrier,pharmacybenefits
manager,oragentthereofthatviolatestheabove.Thepenalty
shallnotexceedarateof$5000perday.
TheDirectorshallpromulgatenecessaryrulesandregulationsto
implementtheprovisionsofthisbill.
Thefollowingisasummaryofthepublictestimonyfromthe
committeehearing. Thetestimonywasbasedontheintroduced
versionofthebill.
PROPONENTS: Supporterssaythatmanyclinicsandpatientsare
reliantonthe340Bprogram,andthattheseallowforadditional
servicessuchasextendedwalk-inandemergencyservices. For
patients,therearenotmanyadditionalavenuestohelpkeep
prescriptioncostsdown,andaretypicallyatthewhimofinsurers
whocanbeselectivewithcoveredtreatmentsordrugs.
TestifyinginpersonforthebillwereRepresentative Wright;
MariahHollabaugh,CitizensMemorialHospital;JodieGregg;K.
ScottZweerink,UniversityHealth;andtheMissouriHospital
Association.
OPPONENTS: Thosewhoopposethebillsaythatcertainpractices
relatedtothe340Bprogram,suchas"white-bagging"drugstobe
shippeddirectlytoapatientforadministration, arecost-saving measures;moreover,apharmacybenefitsmanageristheonly
stakeholderwithintheinsuranceindustrydedicatedtoreducing
costs.Therehasbeenagrowinglackoftransparencywithregard
tooversightoftheprograminsomehospitals,andthislegislation
may,throughavarietyofmeans,raisecostsforprescription
drugs.
TestifyinginpersonagainstthebillwereBlueCrossBlueShield;
AmericasHealthInsurancePlans;MissouriInsuranceCoalition;St.
LouisAreaBusinessHealthCoalition;andthePharmaceutical Care
ManagementAssociation(PCMA).
OTHERS:Otherstestifyingonthebillsaythatthereare
discrepancieswithpaymentspertainingtothepracticesof"white-
bagging"and"brown-bagging",withopposingviewpointssharedon
thebenefitingstakeholder:hospitalsorinsurancecompanies.
Therearesomenotableconcernswithwhite-bagging,suchasthe
spoilingofcertaindrugsorhighcosts,andthatformany
federallyqualifiedhealthcenters(FQHCs),the340Bprogramhas
beenindispensable.
TestifyinginpersononthebillwasPhRMA.
Writtentestimonyhasbeensubmittedforthisbill.Thefull
writtentestimonyandwitnessestestifyingonlinecanbefound
underTestimonyonthebillpageontheHousewebsite.