2018 Regular Session
To: Public Health and Human Services; Insurance
By: Representatives Bell (65th), Banks, Burnett, Calhoun, Clark, Dortch, Faulkner, Hines, Holloway, Jackson, Karriem, Paden, Williams-Barnes
AN ACT TO CREATE THE "NO GAG RULE ON PHARMACISTS ACT"; TO STATE LEGISLATIVE FINDINGS AND DECLARATIONS; TO DEFINE CERTAIN TERMS; TO PROHIBIT HEALTH INSURERS AND PHARMACY BENEFITS MANAGERS FROM REQUIRING CONTRACTS WITH PHARMACISTS TO INCLUDE PROVISIONS THAT PENALIZE PHARMACISTS FOR DISCLOSING PRESCRIPTION DRUG COST INFORMATION, INCLUDING THE AVAILABILITY OF MORE AFFORDABLE ALTERNATIVE MEDICATIONS, TO CUSTOMERS; TO REQUIRE THE COMMISSIONER OF INSURANCE TO ENFORCE THE ACT AND UPON REQUEST, TO CAUSE INSURANCE CONTRACTS TO BE AUDITED; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. This act shall be known and may be cited as the "No Gag Rule on Pharmacists Act."
SECTION 2. (1) The Legislature finds that:
(a) Pharmacy benefits managers (PBMs) are companies that contract with pharmacists to administer the prescription drug benefit component of health benefit plans, setting the co-pay amounts for each drug.
(b) PBMs, on behalf of insurers, often use contract provisions to prohibit pharmacists from informing their customers about less expensive ways to pay for their prescriptions.
(c) In some cases, customers who have not reached their deductible could pay less by purchasing a drug independently of their insurance, but contract provisions required by PBMs prohibit pharmacists from sharing this option with customers.
(d) These contract provisions are unfair to pharmacists who effectively are prohibited from using their professional expertise.
(e) Pharmacy customers are disadvantaged unfairly by this system, as they are financially impacted and also unable to make fully informed decisions on their healthcare choices because they are denied information on potential prescription drug options.
(2) The Legislature declares that the purpose of this act is to protect the health and welfare of residents who need to take prescription drugs.
SECTION 3. As used in this act, the following words and phrases have the meanings ascribed in this section unless the context clearly indicates otherwise:
(a) "Allowable claim amount" means the amount the insurer or pharmacy benefits manager has agreed to pay the pharmacy for the prescription medication.
(b) "Health benefit plan" means any entity or program that provides reimbursement for pharmaceutical services.
(c) "Insurer" means any entity that provides or offers a health benefit plan.
(d) "Pharmacist" means a pharmacist licensed by the Mississippi State Board of Pharmacy.
(e) "Pharmacy" means a place licensed by the Mississippi State Board of Pharmacy.
(f) "Pharmacy benefits manager" or "PBM" means a third party administrator of the prescription drug program of a health benefit plan.
SECTION 4. (1) An insurer or pharmacy benefits manager may not offer or agree to a contract provision that penalizes a pharmacy or pharmacist for disclosing information to a customer regarding:
(a) The cost of a prescription medication to the customer; or
(b) The availability of any therapeutically equivalent alternative medications or alternative methods of purchasing the prescription medication which are less expensive to the customer than the cost of the prescription medication, including, but not limited to, paying a cash price.
(2) A contract provision is deemed to penalize a pharmacy or pharmacist if it prohibits disclosure of information under subsection (1) of this section or if it disadvantages a pharmacy or pharmacist that makes such a disclosure, including through increased utilization review, reduced payments or other financial disincentives.
(3) An insurer or pharmacy benefits manager may not require an individual to make a payment at the point of sale for a covered prescription medication in an amount greater than the lesser of:
(a) The applicable copayment for the prescription medication;
(b) The allowable claim amount for the prescription medication; or
(c) The amount an individual would pay for the prescription medication if the individual purchased the prescription medication without using a health benefit plan or any other source of prescription medication benefits or discounts.
(4) A provision of a contract which violates this act is void and unenforceable and constitutes an unfair trade practice; however, the invalidity or unenforceability of a contract provision under this subsection does not affect any other provision of the contract.
(5) The Commissioner of Insurance shall enforce the provisions of this section and, upon request, may require an audit to be performed on a contract for pharmacy services in order to determine compliance or a failure to comply with the provisions of this section.
SECTION 5. This act shall take effect and be in force from and after July 1, 2018.