MISSISSIPPI LEGISLATURE

2024 Regular Session

To: Public Health and Welfare

By: Senator(s) Bryan

Senate Bill 2861

AN ACT TO AMEND SECTION 73-21-179, MISSISSIPPI CODE OF 1972, TO REVISE CERTAIN DEFINITIONS UNDER THE PHARMACY AUDIT INTEGRITY ACT; AND FOR RELATED PURPOSES.

     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

     SECTION 1.  Section 73-21-179, Mississippi Code of 1972, is amended as follows:

     73-21-179.  For purposes of Sections 73-21-175 through 73-21-189:

          (a)  "Entity" means a pharmacy benefit manager, a managed care company, a health plan sponsor, an insurance company, a third-party payor, or any company, group or agent that represents or is engaged by those entities.

          (b)  "Health insurance plan" means benefits consisting of prescription drugs, other products and supplies, and pharmacist services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as prescription drugs, other products and supplies, and pharmacist services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization agreement, or health maintenance organization contract offered by a health insurance

issuer.

          (c)  "Individual prescription" means the original prescription for a drug signed by the prescriber, and excludes refills referenced on the prescription.

          (d)  "Pharmacy benefit manager" means a business that provides pharmacy benefit management services or administers the prescription drug/device portion of pharmacy benefit management plans or health insurance plans on behalf of plan sponsors, insurance companies, unions and health maintenance organizations. * * * Pharmacy benefit managers may also provide some, all, but may not be limited to, the following services either directly or through outsourcing or contracts with other entities:

  (i)  Adjudicate drug claims or any portion of the transaction.

   (ii)  Contract with retail and mail pharmacy networks.

   (iii)  Establish payment levels for pharmacies.

   (iv)  Develop formulary or drug list of covered therapies.

   (v)  Provide benefit design consultation.

   (vi)  Manage cost and utilization trends.

   (vii)  Contract for manufacturer rebates.

   (viii)  Provide fee‑based clinical services to improve member care.

   (ix)  Third‑party administration.

The term "pharmacy benefit manager" shall not include an insurance company, unless the insurance company is providing services as a pharmacy benefit manager as defined in this section, in which case the insurance company shall be subject to Sections 73-21-151 through 73-21-163 only for those pharmacy benefit manager services.

          (e)  "Pharmacy benefit management plan" means an arrangement for the delivery of pharmacist's services in which a pharmacy benefit manager undertakes to administer the payment or reimbursement of any of the costs of pharmacist's services, * * * for an enrollee on a prepaid or insured basis that (i) contains one or more incentive arrangements intended to influence the cost or level of pharmacist's services between the plan sponsor and one or more pharmacies with respect to the delivery of pharmacist's services; and (ii) requires or creates benefit payment differential incentives for enrollees to use under contract with the pharmacy benefit manager drugs, or devices.

          (f)  Pharmacy benefit management services shall include, but are not limited to, the following services, which may be provided either directly or through outsourcing or contracts with other entities:

(i)  Adjudicate drug claims or any portion of the transaction.

(ii)  Contract with retail and mail pharmacy networks.

(iii)  Establish payment levels for pharmacies.

(iv)   Develop formulary or drug list of covered therapies.

(v)  Provide benefit design consultation.

(vi)   Manage cost and utilization trends.

(vii)  Contract for manufacturer rebates.

(viii)  Provide fee-based clinical services to improve member care

(ix)  Third-party administration.

(x)  Sponsoring or providing cash discount cards as defined in Section 83-9-6.1.

(g)  "Pharmacist," "pharmacist services" and "pharmacy" or "pharmacies" shall have the same definitions as provided in

Section 73-21-73.

     SECTION 2.  This act shall take effect and be in force from and after July 1, 2024.

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