Senate Bill 2716

AN ACT TO ESTABLISH THE "COMMISSION ON MISSISSIPPI PHARMACY BENEFITS MANAGER (PBM) AND MISSISSIPPI VISION BENEFITS MANAGER (VBM)LICENSURE ISSUES" TO STUDY AND DEVELOP RECOMMENDATIONS TO THE LEGISLATURE ON COMPREHENSIVE LICENSURE REVISIONS AND OVERSIGHT; TO PRESCRIBE THE MEMBERSHIP OF THE COMMISSION AND AUTHORIZE THE COMMISSION TO ORGANIZE, HOLD HEARINGS AND MAKE ITS REPORT; TO PRESCRIBE ISSUES FOR THE COMMISSION TO CONSIDER; AND FOR RELATED PURPOSES.

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

SECTION 1. (1) There is hereby established the Commission on Mississippi Pharmacy Benefits Manager (PBM) and Mississippi Vision Benefits Manager (VBM) Issues to study and develop recommendations to the Legislature and the Mississippi Department of Insurance regarding comprehensive licensure revisions and oversight of network adequacy and compensation requirements for PBMs and VBMs.

(a) The members of the commission shall be as follows:

(i) The Chairmen of the Senate Committee on Accountability, Efficiency and Transparency and the House Committee on Accountability, Efficiency and Transparency;

(ii) The Chairmen of the Senate Committee on Insurance and the House Committee on Insurance;

(iii) A representative of the State Board of Pharmacy appointed by the board;

(iv) A representative of the State Board of Optometry appointed by the board;

(v) Two (2) licensed pharmacists, one (1) appointed by the Lieutenant Governor and one (1) by the Speaker of the House, respectively;

(vi) Two (2) licensed optometrists, one (1) appointed by the Lieutenant Governor and one (1) appointed by the Speaker of the House, respectively;

(vii) One (1) representative of the current PBM organizations appointed by the Lieutenant Governor; and

(viii) One (1) representative of the current VBM organizations appointed by the Speaker of the House; and

(ix) The Mississippi Commissioner of Insurance, or his designee.

(b) The commission shall meet within forty-five (45) days of the effective date of this section, upon the call of the Governor, and shall organize for business. The commission shall elect a chair from among the members. The commission shall develop and report its findings and any recommendations for proposed legislation to the Governor, the Legislature and the Mississippi Department of Insurance on or before December 1, 2024. A quorum of the membership shall be required to approve any final report and recommendation. Members of the commission shall be reimbursed from any available funds for necessary travel expense in the same manner as public employees are reimbursed for official duties and members of the Legislature shall be reimbursed in the same manner for attending out-of-session committee meetings.

(i) Consider legislation which places comprehensive licensure and oversight over PBMs operating in Mississippi.

(ii) Empowering an appropriate state agency to serve as the regulator for PBMs.

(iii) A PBM must have an active license to do business in Mississippi, and if a PBM violates any statues or rules pertaining to PBMs, their license can be fined, suspended or revoked.

(iv) Any PBM Licensure Act will not interfere with Any Willing Provider (AWP), the Pharmacy Audit Bill of Rights, the Maximum Allowable Cost Act, or other statutory protections already in the law.

(v) Consider legislation under which a PBM would be required to:

1. Provide an adequate and accessible pharmacy benefits manager network for health benefits plans (mail order pharmacies are not allowed to ensure an adequate network);

2. Provide for a compensation program for the reimbursement of pharmacist services that are paid to a pharmacist or pharmacy that is "fair and reasonable" to be able to maintain an adequate network;

3. The Insurance Commissioner can write rules and regulations to put more specific parameters around the network adequacy and compensation requirements.

(vi) Consider legislation under which PBMs will also be prohibited from doing the following acts:

1. Using untrue, deceptive or misleading solicitations or advertisements;

2. Charging a pharmacy or pharmacist fees related to adjudication of a claim, without review and approval by the Insurance Commissioner;

3. Requiring accreditation or certification requirements more stringent than the Mississippi State Board of Pharmacy without approval from the Insurance Commissioner, in coordination with the Mississippi State Board of Pharmacy;

4. Paying a PBM's own pharmacy or pharmacist more than they pay a Mississippi pharmacy or pharmacist for providing the same pharmacist service;

5. Denying or reducing a paid claim retroactively, unless it was fraudulently submitted or the service was not properly rendered;

6. Keeping money from a pharmacy in the event the pharmacy is terminated from a network;

7. Placing a prohibition over the pharmacist or pharmacy from sharing data with the patient or government entities.

(vi) Consider legislation which places comprehensive licensure and oversight over VBMs operating in Mississippi by empowering an appropriate state agency to serve as the regulator for VBMs.

(vii) A VBM must have an active license to do business in Mississippi, and if a VBM violates any statues or rules pertaining to VBMs, their license can be fined, suspended or revoked.

(viii) Any VBM Licensure Act will not interfere with Any Willing Provider (AWP) or other statutory protections already in the law.

(ix) Consider legislation under which a VBM would be required to:

1. Provide an adequate and accessible vision benefits manager network for health benefits plans (mail order entities are not allowed to ensure an adequate network);

2. Provide for a compensation program for the reimbursement of optometrists' services that are paid to an optometrist that is "fair and reasonable" to be able to maintain an adequate network;

3. There are rules and regulations to put more specific parameters around the network adequacy and compensation requirements.

(x) Consider legislation under which VBMs will also be prohibited from doing the following acts:

1. Using untrue, deceptive or misleading solicitations or advertisements;

2. Charging an optometrist fee related to adjudication of a claim, without review and approval by the Insurance Commissioner;

3. Requiring accreditation or certification requirements more stringent than the Mississippi State Board of Optometry without approval from the Insurance Commissioner, in coordination with the Mississippi State Board of Optometry;

4. Paying a VBM's own optical or optometrist more than they pay a Mississippi optical or optometrist for providing the same optometrist service;

5. Denying or reducing a paid claim retroactively, unless it was fraudulently submitted or the service was not properly rendered;

6. Keeping money from an optometrist in the event the optometrist is terminated from a network;

7. Placing a prohibition over the optical or optometrist from sharing data with the patient or government entities.

(xi) Any necessary revisions to the Pharmacy Benefit Prompt Pay Act or the Pharmacy Practice Licensure Law or the Optometry Practice Act.

(d) Upon making its report, the commission shall be dissolved.

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