MISSISSIPPI LEGISLATURE
2019 Regular Session
To: Insurance; Public Health and Human Services
By: Representative Mettetal
AN ACT TO CREATE NEW SECTION 83-9-6.5, MISSISSIPPI CODE OF 1972, TO REQUIRE INSURERS THAT MAY CHARGE HEALTH BENEFIT PLAN ENROLLEES EXCESS COST SHARING AMOUNTS TO PROVIDE NOTICE OF SUCH TO ENROLLEES AND PROSPECTIVE ENROLLEES; TO REQUIRE PHARMACY BENEFIT MANAGERS TO ANNUALLY CERTIFY TO THE STATE BOARD OF PHARMACY THAT, DURING THE PRIOR BENEFIT YEAR, THE INSURER MADE AVAILABLE TO ENROLLEES AT THE POINT OF SALE AT LEAST A MAJORITY OF REBATES; TO REQUIRE THE STATE BOARD OF PHARMACY TO MAKE CERTAIN NOTIFICATIONS TO THE COMMISSIONER OF INSURANCE; TO PROVIDE FOR CONFIDENTIALITY OF INFORMATION REGARDING THE ACTUAL AMOUNT OF REBATES THE INSURER RECEIVED ON A PRODUCT-SPECIFIC OR MANUFACTURER-SPECIFIC BASIS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. The following shall be codified as Section 83-9-6.5, Mississippi Code of 1972:
83-9-6.5. (1) As used in this section the following terms shall have the following meanings unless the context clearly indicates otherwise:
(a) "Excess cost sharing" means a deductible payment, copayment, or coinsurance amount charged to an enrollee for a covered prescription drug that is greater than the amount that an enrollee’s insurer would pay absent the enrollee cost sharing, after accounting for rebates.
(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) "Pharmacy benefit manager" means any entity as defined by Section 73-21-179(d).
(e) "Rebate" means:
(i) Negotiated price concessions, including but not limited to base rebates and reasonable estimates of any price protection rebates and performance based rebates that may accrue directly or indirectly to the insurer during the coverage year from a manufacturer; and
(ii) Reasonable estimates of any fees and other administrative costs that are passed through to the insurer and serve to reduce the insurer’s prescription drug liabilities for the coverage year.
(2) An insurer that may charge enrollees cost sharing amounts that may result in excess cost sharing for covered prescription drugs shall disclose to enrollees and prospective enrollees the fact that enrollees may be subject to such excess cost sharing. Such notice shall be provided in health benefit plan documents, including but not limited to in evidence of coverage materials, formulary or preferred drug guides, and all marketing materials.
(3) A pharmacy benefit manager shall annually certify to the State Board of Pharmacy that, during the prior benefit year, the insurer made available to enrollees at the point of sale at least a majority (i.e., greater than fifty percent (50%)) of rebates.
(4) The State Board of Pharmacy shall notify the Commissioner of Insurance of any health benefit plan or pharmacy benefit manager providing pharmaceutical services that does not conform to the requirements in this section and make this information easily accessible to the public on the State Board of Pharmacy website.
(5) In providing the certification and disclosures required under this section, a pharmacy benefit manager shall not publish or otherwise reveal information regarding the actual amount of rebates the insurer received on a product-specific or manufacturer-specific basis. Such information is protected as a trade secret, is not regarded as a public record under Section 25-61-1 et seq., and shall not be disclosed directly or indirectly. A pharmacy benefit manager shall impose the confidentiality protections of this section on any vendor or downstream third party that may receive or have access to rebate information.
SECTION 2. This act shall take effect and be in force from and after July 1, 2019.