MISSISSIPPI LEGISLATURE
2025 Regular Session
To: Public Health and Welfare
By: Senator(s) Parks, Whaley, Hill, Younger, Parker, Williams, Berry, Chassaniol, McCaughn, Hopson, Blackwell, McLendon, Rhodes, Barrett
AN ACT TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE NEW SECTIONS IN THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE NEW TERMS AND REVISE THE DEFINITIONS OF EXISTING TERMS UNDER THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO REQUIRE A PHARMACY BENEFIT MANAGER TO MAKE PROMPT PAYMENT TO A PHARMACY; TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO PROVIDE A REASONABLE ADMINISTRATIVE APPEAL PROCEDURE TO ALLOW PHARMACIES TO CHALLENGE A REIMBURSEMENT FOR A SPECIFIC DRUG OR DRUGS AS BEING BELOW THE REIMBURSEMENT RATE REQUIRED BY THE PRECEDING PROVISION; TO PROVIDE THAT IF THE APPEAL IS UPHELD, THE PHARMACY BENEFIT MANAGER SHALL MAKE THE CHANGE IN THE PAYMENT TO THE REQUIRED REIMBURSEMENT RATE; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE A PHARMACY SERVICES ADMINISTRATIVE ORGANIZATION (PSAO) TO BE LICENSED WITH THE MISSISSIPPI BOARD OF PHARMACY; TO REQUIRE A PSAO TO PROVIDE TO A PHARMACY OR PHARMACIST A COPY OF ANY CONTRACT ENTERED INTO ON BEHALF OF THE PHARMACY OR PHARMACIST BY THE PSAO; TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER, PSAO, CARRIER OR HEALTH PLAN FROM SPREAD PRICING; TO AMEND SECTION 73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER OR PHARMACY BENEFIT MANAGER AFFILIATES FROM ORDERING A PATIENT TO USE A SPECIFIC PHARMACY OR PHARMACIES, INCLUDING AN AFFILIATE PHARMACY; OFFERING OR IMPLEMENTING PLAN DESIGNS THAT PENALIZE A PATIENT WHEN A PATIENT CHOOSES NOT TO USE A PARTICULAR PHARMACY, INCLUDING AN AFFILIATE PHARMACY; ADVERTISING OR PROMOTING A PHARMACY, INCLUDING AN AFFILIATE PHARMACY, OVER ANOTHER IN-NETWORK PHARMACY; CREATING NETWORK OR ENGAGING IN PRACTICES THAT EXCLUDE AN IN-NETWORK PHARMACY; ENGAGING IN A PRACTICE THAT ATTEMPTS TO LIMIT THE DISTRIBUTION OF A PRESCRIPTION DRUG TO CERTAIN PHARMACIES; INTERFERING WITH THE PATIENT'S RIGHT TO CHOOSE THE PATIENT'S PHARMACY OR PROVIDER OF CHOICE; TO PROVIDE THAT THIS SECTION DOES NOT APPLY TO FACILITIES LICENSED TO FILL PRESCRIPTIONS SOLELY FOR EMPLOYEES OF A PLAN SPONSOR OR EMPLOYER; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS (PSAOS) FROM PENALIZING OR RETALIATING AGAINST A PHARMACIST, PHARMACY OR PHARMACY EMPLOYEE FOR EXERCISING ANY RIGHTS UNDER THIS ACT, INITIATING ANY JUDICIAL OR REGULATORY ACTIONS, OR APPEARING BEFORE ANY GOVERNMENTAL AGENCY, LEGISLATIVE MEMBER OR BODY OR ANY JUDICIAL AUTHORITY; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE BOARD OF PHARMACY, FOR THE PURPOSES OF CONDUCTING INVESTIGATIONS, TO CONDUCT EXAMINATIONS OF A PHARMACY BENEFIT MANAGER OR PSAO AND TO ISSUE SUBPOENAS TO OBTAIN DOCUMENTS OR RECORDS THAT IT DEEMS RELEVANT TO THE INVESTIGATION; TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE EACH DRUG MANUFACTURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES THE CURRENT WHOLESALE ACQUISITION COST; TO REQUIRE SUCH ENTITIES TO PROVIDE THE BOARD OF PHARMACY WITH VARIOUS DRUG PRICING INFORMATION WITHIN A CERTAIN TIME; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO FILE A REPORT WITH THE BOARD OF PHARMACY; TO REQUIRE EACH HEALTH INSURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES CERTAIN DRUG PRESCRIPTION INFORMATION; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD OF PHARMACY TO DEVELOP A WEBSITE TO PUBLISH INFORMATION RELATED TO THE ACT; TO CREATE NEW SECTION 73-21-169, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO IDENTIFY OWNERSHIP AFFILIATION OF ANY KIND TO THE BOARD OF PHARMACY; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 73-21-151, Mississippi Code of 1972, is amended as follows:
73-21-151. Sections 73-21-151
through * * *
73-21-169 shall be known as the "Pharmacy Benefit Prompt Pay
Act."
SECTION 2. Section 73-21-153, Mississippi Code of 1972, is amended as follows:
73-21-153. For purposes of
Sections 73-21-151 through * * * 73-21-169, the
following words and phrases shall have the meanings ascribed herein unless the
context clearly indicates otherwise:
(a) "Board"
means the * * *
Mississippi Board of Pharmacy.
(b) "Clean claim" means a completed billing instrument, paper or electronic, received by a pharmacy benefit manager from a pharmacist or pharmacies or the insured, which is accepted and payment remittance advice is provided by the pharmacy benefit manager. A clean claim includes resubmitted claims with previously identified deficiencies corrected.
( * * *c) "Commissioner" means the
Mississippi Commissioner of Insurance.
( * * *d) "Day" means a calendar
day, unless otherwise defined or limited.
( * * *e) "Electronic claim" means
the transmission of data for purposes of payment of covered prescription drugs,
other products and supplies, and pharmacist services in an electronic data
format specified by a pharmacy benefit manager and approved by the department.
( * * *f) "Electronic adjudication"
means the process of electronically receiving * * * and reviewing an electronic claim
and either accepting and providing payment remittance advice for the
electronic claim or rejecting * * * the electronic claim.
( * * *g) "Enrollee" means an
individual who has been enrolled in a pharmacy benefit management plan or
health insurance plan.
( * * *h) "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.
(i) "Network pharmacy" means a pharmacy licensed by the board and provides pharmacy services to Mississippi consumers and has a contract with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate.
(j) "Payment remittance advice" means the claim detail that the pharmacy receives when successfully processing an electronic or paper claim. The claim detail shall contain, but is not limited to:
(i) The amount that the pharmacy benefit manager will reimburse for product ingredient; and
(ii) The amount that the pharmacy benefit manager will reimburse for product dispensing fee; and
(iii) The amount that the pharmacy benefit manager dictates the patient must pay.
(k) "Pharmacist" and "pharmacy" shall have the same definition as provided in Section 73-21-73.
(* * *l) "Pharmacy benefit
manager" * * *
means an entity that provides pharmacy benefit management services. * * *
The term "pharmacy benefit manager" shall not include:
(i) An
insurance company unless the insurance company is providing services as a
pharmacy benefit manager * * * as defined in Section 73‑21‑179, in which case
the insurance company shall be subject to Sections 73-21-151 through * * * 73-21-169 only
for those pharmacy benefit manager services * * *; and
(ii) The Mississippi Division of Medicaid or its contractors when performing pharmacy benefit manager services for the Division of Medicaid.
( * * *m) "Pharmacy benefit manager
affiliate" means * * * an entity that directly or
indirectly, * * * owns or controls, is owned or controlled
by, or is under common ownership or control with a pharmacy benefit manager.
( * * *n) "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, drugs or devices.
* * *
(o) "Pharmacy benefit management services" shall include, but is not limited to, the following services, which may be provided either directly or through outsourcing or contracts:
(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, and also electronic discount cards.
(p) "Pharmacist services" means products, goods and services, or any combination of products, goods and services, provided as part of the practice of pharmacy.
(q) "Pharmacy services administrative organization" or "PSAO" means any entity that contracts with a pharmacy or pharmacist to assist with third-party payor interactions and that may provide a variety of other administrative services, including, but not limited to, contracting with third-party payers or pharmacy benefit managers on behalf of pharmacies and providing pharmacies or pharmacists with credentialing, billing, audit, general business and analytic support.
(r) "Plan sponsors" means the employers, insurance companies, unions and health maintenance organizations that contract, either directly or indirectly, with a pharmacy benefit manager for delivery of prescription drugs and/or services.
(s) "Proprietary information" means information on pricing, costs, revenue, taxes, market share, negotiating strategies, customers and personnel that is held by a pharmacy benefit manager or PSAO and used for its business purposes.
(t) "Rebate" means any and all payments and price concessions that accrue to a pharmacy benefit manager or its plan sponsor client, directly or indirectly, including through an affiliate, subsidiary, third party or intermediary, including off-shore group purchasing organizations, from a pharmaceutical manufacturer, its affiliate, subsidiary, third party or intermediary, including, but not limited, to payments, discounts, administration fees, credits, incentives or penalties associated directly or indirectly in any way with claims administered on behalf of a plan sponsor.
(u) "Spread pricing" means any amount charged or claimed by a pharmacy benefit manager or PSAO in excess of the ingredient cost for a dispensed prescription drug plus dispensing fee paid directly or indirectly to any pharmacy, pharmacist or other provider on behalf of the health benefit plan, less a pharmacy benefit management or PSAO fee.
( * * *v) "Uniform claim form"
means a form prescribed by rule by the * * * board; however,
for purposes of Sections 73-21-151 through * * * 73-21-169, the
board shall adopt the same definition or rule where the State Department of
Insurance has adopted a rule covering the same type of claim. The board may
modify the terminology of the rule and form when necessary to comply with the
provisions of Sections 73-21-151 through * * * 73-21-169.
* * *
(w) "Wholesale acquisition cost" means the wholesale acquisition cost of the drug as defined in 42 USC§ 1395w-3a(c)(6)(B).
SECTION 3. Section 73-21-155, Mississippi Code of 1972, is amended as follows:
73-21-155. (1) Any
reimbursement under a contract to a pharmacist or pharmacy for prescription
drugs and other products and supplies * * * shall be calculated according
to a formula that uses * * * a nationally recognized reference,
which may include the wholesale acquisition cost, average wholesale price,
national average drug acquisition cost, or a nationally recognized reference
that has been approved by the board * * *.
(2) Pharmacy benefit managers, their agents and other parties responsible for reimbursement for prescription drugs and other products and supplies shall be required to update the nationally recognized reference prices or amounts used for calculation of reimbursement for prescription drugs and other products and supplies no less than every three (3) business days.
(3) (a) All benefits
payable * * *
from a pharmacy benefit * * * manager shall be paid
within seven (7) days after receipt of * * * a clean electronic
claim where * * * the claim was electronically adjudicated,
and shall be paid within thirty-five (35) days after receipt of due written
proof of a clean claim where claims are submitted in paper format. Benefits * * * are overdue if
not paid within seven (7) days or thirty-five (35) days, whichever is
applicable, after the pharmacy benefit manager receives a clean claim
containing necessary information essential for the pharmacy benefit manager to
administer preexisting condition, coordination of benefits and subrogation
provisions under the plan sponsor's health insurance plan. * * *
* * *
( * * *b) * * * If an electronic
claim is denied, the pharmacy benefit manager shall * * * notify the pharmacist or pharmacy * * *
within seven (7) days of the reasons why the claim or portion thereof is
not clean and will not be paid and what substantiating documentation and
information is required to adjudicate the claim as clean. * * * If a written claim is denied, the
pharmacy benefit manager shall notify the pharmacy or pharmacies no later
than thirty-five (35) days * * * of receipt of such claim * * *. The pharmacy benefit manager shall * * * notify the pharmacist or pharmacy * * *
of the reasons why the claim or portion thereof is not clean and will not be
paid and what substantiating documentation and information is required to adjudicate
the claim as clean. Any claim or portion thereof resubmitted with the
supporting documentation and information requested by the pharmacy benefit
manager shall be paid within twenty (20) days after receipt.
(4) If the board finds that
any pharmacy benefit manager, agent or other party responsible for
reimbursement for prescription drugs and other products and supplies has not
paid ninety-five percent (95%) of clean claims as defined in subsection (3) of
this section received from all pharmacies in a calendar quarter, * * * such pharmacy benefit manager, agent or
other party responsible for reimbursement for prescription drugs and other
products and supplies shall be subject to an administrative penalty
of not more than Twenty-five Thousand Dollars ($25,000.00) to be assessed by
the * * * board.
(a) Examinations to
determine compliance with this subsection may be conducted by the board. The
board may contract with qualified impartial outside sources to assist in examinations
to determine compliance. * * * The expenses of any such examinations shall be paid by the pharmacy
benefit manager examined.
(b) Nothing in the provisions of this section shall require a pharmacy benefit manager to pay claims that are not covered under the terms of a contract or policy of accident and sickness insurance or prepaid coverage.
* * *
( * * *c) Any pharmacy benefit manager and a
pharmacy may enter into an express written agreement containing timely claim
payment provisions which differ from, but are at least as stringent as, the
provisions set forth under subsection (3) of this section, and in such case,
the provisions of the written agreement shall govern the timely payment of
claims by the pharmacy benefit manager to the pharmacy. If the express written
agreement is silent as to any interest penalty where claims are not paid in
accordance with the agreement, the interest penalty provision of subsection * * * (5) of this section shall apply.
( * * *d) The * * * board may adopt
rules and regulations necessary to ensure compliance with this subsection.
(5) * * * If * * * a clean claim is not paid or is
denied * * *
without providing to the pharmacy a valid and proper * * * reason as to why the claim is not
clean by the end of the applicable time period prescribed in this * * * section, the pharmacy benefit
manager must pay the pharmacy (where the claim is owed to the pharmacy) or the
patient (where the claim is owed to a patient) interest on accrued benefits at
the rate of one and one half percent (1 1/2%) per month accruing from the day
after payment was due on the amount of the benefits that remain unpaid until
the claim is finally settled or adjudicated. Whenever interest due pursuant to
this * * *
subsection is less than One Dollar ($1.00), such amount shall be
credited to the account of the person or entity to whom such amount is owed.
(6) (a) * * * A network pharmacy or pharmacist may decline to
provide a brand name drug, * * * generic drug, biosimilar drug
or service, if the network pharmacy or pharmacist is paid less than that
network pharmacy's * * * cost for the * * * prescription. If the network
pharmacy or pharmacist declines to provide such drug or service, the pharmacy
or pharmacist shall provide the customer with adequate information as to where
the prescription for the drug or service may be filled.
(b) The * * * board shall
adopt rules and regulations necessary to implement and ensure compliance with
this subsection, including, but not limited to, rules and regulations that
address access to pharmacy services in rural or underserved areas and also
in cases where a network pharmacy or pharmacist declines to provide a drug or
service under paragraph (a) of this subsection. * * *
( * * *7) A pharmacy benefit manager or
PSAO shall not, directly or indirectly, retroactively deny or
reduce a claim or aggregate of claims after the claim or aggregate of claims
has been adjudicated.
SECTION 4. Section 73-21-156, Mississippi Code of 1972, is amended as follows:
73-21-156. (1) As used in this section, the following terms shall be defined as provided in this subsection:
(a) "Maximum allowable
cost list" means a listing of drugs or other methodology used by a
pharmacy benefit manager, directly or indirectly, setting the maximum allowable
payment to a pharmacy or pharmacist for a generic drug, brand-name drug,
biologic product or other prescription drug. The * * * "maximum allowable cost list" utilized
by a pharmacy benefit manager shall comply with Section 73-21-155 and
includes * * *
any * * * term that a pharmacy benefit manager or
a health care insurer may use to establish reimbursement rates to a pharmacist
or pharmacy for pharmacist services.
(b) "Pharmacy acquisition cost" means the amount that a pharmaceutical wholesaler charges for a pharmaceutical product as listed on the pharmacy's billing invoice.
(2) Before a pharmacy benefit manager places or continues a particular drug on a maximum allowable cost list, the drug:
(a) If the drug is a generic equivalent drug product as defined in Section 73-21-73, shall be listed as therapeutically equivalent and pharmaceutically equivalent "A" or "B" rated in the United States Food and Drug Administration's most recent version of the "Orange Book" or "Green Book" or have an NR or NA rating by Medi-Span, Gold Standard, or a similar rating by a nationally recognized reference approved by the board;
(b) Shall be available for purchase by each pharmacy in the state from national or regional wholesalers operating in Mississippi; and
(c) Shall not be obsolete.
(3) A pharmacy benefit manager shall:
(a) Provide access to its maximum allowable cost list to each pharmacy subject to the maximum allowable cost list;
(b) Update its maximum allowable cost list on a timely basis, but in no event longer than three (3) calendar days; and
(c) Provide a process for each pharmacy subject to the maximum allowable cost list to receive prompt notification of an update to the maximum allowable cost list.
(4) A pharmacy benefit manager shall:
(a) Provide a
reasonable administrative appeal procedure to allow pharmacies to challenge * * *
reimbursements made * * * for a specific drug or drugs as:
(i) Not meeting the requirements of this section; or
(ii) Being below the pharmacy acquisition cost.
(b) The reasonable administrative appeal procedure shall include the following:
(i) A * * * direct telephone number,
email address and website for the purpose of submitting administrative appeals;
(ii) The website of the pharmacy benefit manager shall include easily accessible administrative appeal instructions, including listing any required information to be submitted by pharmacies for the purpose of submitting administrative appeals;
( * * *iii) The ability to submit an
administrative appeal or a claim appeal report for multiple claims
directly to the pharmacy benefit manager * * *
or through a * * * PSAO;
and
( * * *iv) A period of less than thirty
(30) business days to file an administrative appeal.
(c) The pharmacy
benefit manager shall respond to the challenge under paragraph (a) of this
subsection (4) within thirty (30) * * * days after receipt of the challenge.
(d) If a challenge is
made under paragraph (a) of this subsection (4), the pharmacy benefit manager
shall within thirty (30) * * * business days after receipt of the challenge either:
(i) * * * Uphold
the appeal * * *
and adjust the reimbursement paid to the pharmacist or pharmacy
to no less than the pharmacy acquisition cost, as documented on the
pharmacist’s or pharmacy’s billing invoice, or as provided in the claim appeal
report, and make the * * * change under item 1 of this subparagraph (i) adjustment
effective for each * * * pharmacy that filed a claim for that NDC on the same
day of service and was reimbursed at or below the challenged rate; or
(ii) * * * Deny
the appeal * * *
and provide the * * * reason
for the denial in writing to the pharmacist or pharmacy.
(e) The board may adopt rules and regulations necessary to ensure compliance with this subsection.
(5) A pharmacy benefit manager shall not deny an appeal submitted pursuant to subsection (4) of this section based upon an existing contract with the pharmacy that provides for a reimbursement rate lower than the pharmacy acquisition cost.
(6) A pharmacy or pharmacist that belongs to a PSAO shall be provided a true and correct copy of any contract and contract amendment that the PSAO enters into with a pharmacy benefit manager or third-party payer on the pharmacy's or pharmacist's behalf.
( * * *7) * * * A pharmacy benefit manager shall not
reimburse a pharmacy or pharmacist in the state an amount less than the amount
that the pharmacy benefit manager reimburses a pharmacy benefit manager
affiliate for providing the same * * * drug or drugs. * * *
The reimbursement amount for such drug or drugs shall be
calculated on a per unit basis based on the same brand and generic product
identifier or brand and generic code number.
SECTION 5. Section 73-21-157, Mississippi Code of 1972, is amended as follows:
73-21-157. (1) Before beginning to do business as a pharmacy benefit manager or PSAO, a pharmacy benefit manager or PSAO shall obtain a license to do business from the board. To obtain a license, the applicant shall submit an application to the board on a form to be prescribed by the board. This license shall be renewed annually.
(2) When applying for a
license or renewal of a license, each pharmacy benefit manager * * *
or PSAO shall file * * * a statement with the board * * *
:
(a) A copy of a certified audit report, if the pharmacy benefit manager has been audited by a certified public accountant within the last twenty-four (24) months; or
( * * *b) If the pharmacy benefit manager
has not been audited in the last twenty-four (24) months, a financial
statement of the organization, including its balance sheet and income statement
for the preceding year which shall be verified by at least two (2) principal
officers; and
( * * *c) Any other information relating to
the operations of the pharmacy benefit manager required by the board * * *.
( * * *3) (a) Any information required to be
submitted to the board pursuant to licensure application that is considered
proprietary by a pharmacy benefit manager or PSAO shall be marked as
confidential when submitted to the board. All such information shall not be
subject to the provisions of the federal Freedom of Information Act or the
Mississippi Public Records Act and shall not be released by the board unless
subject to an order from a court of competent jurisdiction. The board shall
destroy or delete or cause to be destroyed or deleted all such information
thirty (30) days after the board determines that the information is no longer
necessary or useful.
(b) Any person who knowingly releases, causes to be released or assists in the release of any such information shall be subject to a monetary penalty imposed by the board in an amount not exceeding Fifty Thousand Dollars ($50,000.00) per violation. When the board is considering the imposition of any penalty under this paragraph (b), it shall follow the same policies and procedures provided for the imposition of other sanctions in the Pharmacy Practice Act. Any penalty collected under this paragraph (b) shall be deposited into the special fund of the board and used to support the operations of the board relating to the regulation of pharmacy benefit managers.
(c) All employees of the board who have access to the information described in paragraph (a) of this subsection shall be fingerprinted, and the board shall submit a set of fingerprints for each employee to the Department of Public Safety for the purpose of conducting a criminal history records check. If no disqualifying record is identified at the state level, the Department of Public Safety shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history records check.
( * * *4) * * *
The board may waive the requirements for filing
financial information for the pharmacy benefit manager if an affiliate of the
pharmacy benefit manager is already required to file such information under
current law with the Commissioner of Insurance and allow the pharmacy benefit
manager to file a copy of documents containing such information with the board
in lieu of the statement required by this section.
( * * *5) The expense of administering this
section shall be assessed annually by the board against all pharmacy benefit
managers and PSAOs operating in this state.
( * * *6) A pharmacy benefit manager, PSAO
or third-party payor * * * shall not require pharmacy accreditation standards or * * * certification
requirements inconsistent with, more stringent than, or in addition to federal
and state requirements for licensure as a pharmacy in this state.
SECTION 6. The following shall be codified as Section 73-21-158, Mississippi Code of 1972:
73-21-158. (1) No pharmacy benefit manager, PSAO, carrier or health benefit plan may, either directly or through an intermediary, agent or affiliate engage in, facilitate or enter into a contract with another person involving spread pricing in this state.
(2) A pharmacy benefit manager or PSAO contract with a carrier or health benefit plan entered into, renewed or amended on or after the effective date of this act must:
(a) Specify all forms of revenue, including pharmacy benefit management or PSAO fees, to be paid by the carrier or health benefit plan to the pharmacy benefit manager or PSAO; and
(b) Acknowledge that spread pricing is not permitted in accordance with this section.
(3) Subsections (1) and (2) of this section shall not apply to self-insured plans.
(4) Every pharmacy benefit manager and PSAO shall disclose to the plan sponsor or employer one hundred percent (100%) of all rebates and other payments that the pharmacy benefit manager or PSAO receives directly or indirectly from pharmaceutical manufacturers and/or rebate aggregators in connection with claims administered on behalf of the plan sponsor or employer and the recipients of such rebates. In addition, a pharmacy benefit manager or PSAO shall report annually to each plan sponsor or employer the aggregate amount of all rebates and
other payments and the recipients of such rebates.
(5) This section shall stand repealed on June 30, 2028.
SECTION 7. Section 73-21-161, Mississippi Code of 1972, is amended as follows:
73-21-161. (1) As used in
this section, the term " * * *steering" means:
(a) Directing,
ordering * * *,
or requiring a patient to use a specific affiliate pharmacy * * * or pharmacies, for the
purpose of filling a prescription or receiving services or other care from a
pharmacist;
(b) Offering or
implementing health insurance plan designs that require * * * a beneficiary to * * * utilize an affiliate
pharmacy or pharmacies, or that increases costs to a patient, including
requiring a patient to pay the full cost for a prescription drug when such
patient chooses not to use a pharmacy benefit manager affiliate pharmacy; * * *
(c) * * *
Advertising, marketing, or * * * promoting an
affiliate * * *
pharmacy or pharmacies, over another in-network pharmacy;
(d) Creating any network or engaging in any practice, including accreditation or credentialing standards, day supply limitations or delivery methods limitations, that exclude an in-network pharmacy or restrict an in-network pharmacy from filling a prescription for a prescription drug; or
(e) Directly or indirectly engaging in any practice that attempts to influence or induce a pharmaceutical manufacturer to limit the distribution of a prescription drug to a small number of pharmacies or certain types of pharmacies, or to restrict distribution of such drug to nonaffiliate pharmacies.
The term " * * *steering" does not include
a pharmacy's inclusion by a pharmacy benefit manager or pharmacy benefit
manager affiliate in communications to patients, including patient and
prospective patient specific communications, regarding network pharmacies and
prices, provided that the pharmacy benefit manager or a pharmacy benefit
manager affiliate includes information regarding eligible nonaffiliate
pharmacies in those communications and the information provided is accurate.
(2) A pharmacy, pharmacy benefit manager, or pharmacy benefit manager affiliate licensed or operating in Mississippi shall be prohibited from:
(a) * * * Steering;
(b) Transferring or sharing records relative to prescription information containing patient identifiable and prescriber identifiable data to or from a pharmacy benefit manager affiliate for any commercial purpose; however, nothing in this section shall be construed to prohibit the exchange of prescription information between a pharmacy and its affiliate for the limited purposes of pharmacy reimbursement; formulary compliance; pharmacy care; public health activities otherwise authorized by law; or utilization review by a health care provider; or
(c) Presenting a claim
for payment to any individual, third-party payor, affiliate, or other entity
for a service furnished * * * pursuant to a referral by steering from * * * a pharmacy benefit manager or pharmacy
benefit manager affiliate * * *; or
(d) Interfering with the patient's right to choose the patient's pharmacy or provider of choice, including inducement, required referrals or offering financial or other incentives or measures that would constitute a violation of Section 83-9-6.
(3) This section shall not
be construed to prohibit a pharmacy from entering into an agreement with a pharmacy
benefit manager or pharmacy benefit manager affiliate to provide pharmacy
care to patients, provided that neither the pharmacy * * * nor
the pharmacy benefit manager or pharmacy benefit manager affiliate violate
subsection (2) of this section and the pharmacy provides the disclosures
required in subsection (1) of this section.
* * *
( * * *4) In addition to any other remedy
provided by law, a violation of this section by a pharmacy shall be grounds for
disciplinary action by the board under its authority granted in this chapter.
( * * *5) A pharmacist who fills a
prescription that violates subsection (2) of this section shall not be liable
under this section.
(6) This section shall not apply to facilities licensed to fill prescriptions solely for employees of a plan sponsor or employer.
SECTION 8. The following shall be codified as Section 73-21-162, Mississippi Code of 1972:
73-21-162. (1) Retaliation is prohibited.
(a) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO shall not retaliate against a pharmacist or pharmacy based on the pharmacist's or pharmacy's exercise of any right or remedy under this chapter. Retaliation prohibited by this section includes, but is not limited to:
(i) Terminating or refusing to renew a contract with the pharmacist or pharmacy;
(ii) Subjecting the pharmacist or pharmacy to an increased frequency of audits, number of claims audited or amount of monies for claims audited; or
(iii) Failing to promptly pay the pharmacist or pharmacy any money owed by the pharmacy benefit manager to the pharmacist or pharmacy.
(b) For the purposes of this section, a pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO is not considered to have retaliated against a pharmacy if the pharmacy benefit manager:
(i) Takes an action in response to a credible allegation of fraud against the pharmacist or pharmacy; and
(ii) Provides reasonable notice to the pharmacist or pharmacy of the allegation of fraud and the basis of the allegation before initiating an action.
(2) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO shall not penalize or retaliate against a pharmacist, pharmacy or pharmacy employee for exercising any rights under this chapter, initiating any judicial or regulatory actions or discussing or disclosing information pertaining to an agreement with a pharmacy benefit manager or a pharmacy benefit manager affiliate when testifying or otherwise appearing before any governmental agency, legislative member or body or any judicial authority.
SECTION 9. Section 73-21-163, Mississippi Code of 1972, is amended as follows:
73-21-163. (1)
Whenever the board has reason to believe that a pharmacy benefit manager * * *, pharmacy benefit manager affiliate or
PSAO is using, has used, or is about to use any method, act or practice
prohibited in * * * this
act and that proceedings would be in
the public interest, it may bring an action in the name of the board against
the pharmacy benefit manager * * *, pharmacy benefit manager affiliate or
PSAO to restrain by temporary or permanent injunction the use of such
method, act or practice. The action shall be brought in the Chancery Court of
the First Judicial District of Hinds County, Mississippi. The court is
authorized to issue temporary or permanent injunctions to restrain and prevent
violations of * * * this
act and such injunctions shall be issued without bond.
(2) The board may impose a
monetary penalty on a pharmacy benefit manager * * *, or a pharmacy benefit
manager affiliate or PSAO for noncompliance with the provisions of * * *
this act, in amounts of not less than One Thousand Dollars ($1,000.00)
per violation and not more than Twenty-five Thousand Dollars ($25,000.00) per violation.
Each day a violation continues for the same brand or generic product identifier
or brand or generic code number is a separate violation. Each day that a
pharmacy benefit manager or PSAO does business in this state without a license
is deemed a separate violation. The board shall prepare a record entered
upon its minutes that states the basic facts upon which the monetary penalty
was imposed. Any penalty collected under this subsection (2) shall be
deposited into the special fund of the board.
(3) For the purposes of conducting investigations, the board, through its executive director, may conduct audits and examinations of a pharmacy benefit manager or PSAO and may also issue subpoenas to any individual, pharmacy, pharmacy benefit manager, PSAO or any other entity having documents or records that it deems relevant to the investigation.
( * * *4) The board may assess a monetary
penalty for those reasonable costs that are expended by the board in the
investigation and conduct of a proceeding if the board imposes a monetary
penalty under subsection (2) of this section. A monetary penalty assessed and
levied under this section shall be paid to the board by the licensee,
registrant or permit holder upon the expiration of the period allowed for
appeal of those penalties under Section 73-21-101, or may be paid sooner if the
licensee, registrant or permit holder elects. Any penalty collected by the
board under this subsection ( * * *4) shall be deposited into the special
fund of the board.
( * * *5) When payment of a monetary penalty
assessed and levied by the board against a licensee, registrant or permit
holder in accordance with this section is not paid by the licensee, registrant
or permit holder when due under this section, the board shall have the power to
institute and maintain proceedings in its name for enforcement of payment in
the chancery court of the county and judicial district of residence of the
licensee, registrant or permit holder, or if the licensee, registrant or permit
holder is a nonresident of the State of Mississippi, in the Chancery Court of
the First Judicial District of Hinds County, Mississippi. When those
proceedings are instituted, the board shall certify the record of its
proceedings, together with all documents and evidence, to the chancery court
and the matter shall be heard in due course by the court, which shall review
the record and make its determination thereon in accordance with the provisions
of Section 73-21-101. The hearing on the matter may, in the discretion of the
chancellor, be tried in vacation.
(6) (a) The board may conduct audits to ensure compliance with the provisions of this act. In conducting audits, the board is empowered to request production of documents pertaining to compliance with the provisions of this act, and documents so requested shall be produced within seven (7) days of the request unless extended by the board or its duly authorized staff.
(b) If, after the conclusion of the audit, the pharmacy benefit manager or PSAO was found to be in compliance with all of the requirements of this act, then the board shall pay the costs of the audit. However, the pharmacy benefit manager or PSAO being audited shall pay all costs of such audit if such audit reveals any noncompliance with this act. The cost of the audit examination shall be deposited into the special fund and shall be used by the board, upon appropriation of the Legislature, to support the operations of the board relating to the regulation of pharmacy benefit managers.
(c) The board is authorized to hire independent consultants to conduct audits of a pharmacy benefit manager and expend funds collected under this section to pay the cost of performing audit services.
( * * *7) The board shall develop and
implement a uniform penalty policy that sets the minimum and maximum penalty
for any given violation of * * *
this act. The board shall adhere to its uniform penalty policy except
in those cases where the board specifically finds, by majority vote, that a
penalty in excess of, or less than, the uniform penalty is appropriate. That
vote shall be reflected in the minutes of the board and shall not be imposed
unless it appears as having been adopted by the board.
SECTION 10. The following shall be codified as Section 73-21-165, Mississippi Code of 1972:
73-21-165. (1) Each drug manufacturer shall submit a report to the board no later than the fifteenth day of January, April, July and October with the current wholesale acquisition cost information for the prescription drugs sold in or into the state by that drug manufacturer; provided, however, the first report due under this subsection shall not be due until October 1, 2025.
(2) Not more than thirty (30) days after an increase in wholesale acquisition cost of forty percent (40%) or greater over the preceding five (5) calendar years or ten percent (10%) or greater in the preceding twelve (12) months for a prescription drug with a wholesale acquisition cost of Seventy Dollars ($70.00) or more for a manufacturer-packaged drug container, a drug manufacturer shall submit a report to the board. The report must contain the following information:
(a) The name of the drug;
(b) Whether the drug is a brand name or a generic;
(c) The effective date of the change in wholesale acquisition cost;
(d) Aggregate, company-level research and development costs for the previous calendar year;
(e) Aggregate rebate amounts paid to each pharmacy benefit manager or PSAO for the previous calendar year;
(f) The name of each of the drug manufacturer's drugs approved by the United States Food and Drug Administration in the previous five (5) calendar years;
(g) The name of each of the drug manufacturer's drugs that lost patent exclusivity in the United States in the previous five (5) calendar years; and
(h) A concise statement of rationale regarding the factor or factors that caused the increase in the wholesale acquisition cost, such as raw ingredient shortage or increase in pharmacy benefit manager's or PSAO's rebates.
(2) The quality and types of information and data a drug manufacturer submits to the board pursuant to this section must be the same as the quality and types of information and data the drug manufacturer includes in the drug manufacturer's annual consolidated report on the Securities and Exchange Commission Form 10-K or any other public disclosure. A drug manufacturer shall notify the board in writing if the drug manufacturer is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D Program.
(3) The notice must include a concise statement of rationale regarding the factor or factors that caused the new drug to exceed the Medicare Part D Program price. The drug manufacturer shall
provide the written notice within three (3) calendar days following the release of the drug in the commercial market. A drug manufacturer may make the notification pending approval by the United States Food and Drug Administration if commercial availability is expected within three (3) calendar days following the approval.
(4) On or before October 1st of each year, a pharmacy benefit manager or PSAO providing services for a health care plan shall file a report with the board. The report must contain the
following information for the previous state fiscal year:
(a) The aggregated rebates, fees, price protection payments, and any other payments collected from each drug manufacturer;
(b) The aggregated dollar amount of rebates, price protection payments, fees, and any other payments collected from each drug manufacturer which were passed to health insurers;
(c) The aggregated fees, price concessions, penalties, effective rates, and any other financial incentive collected from pharmacies which were passed to enrollees at the point of sale;
(d) The aggregated dollar amount of rebates, price protection payments, fees, and any other payments collected from drug manufacturers which were retained as revenue by the pharmacy benefit manager or PSAO; and
(e) The aggregated rebates passed on to employers.
(5) Reports submitted by pharmacy benefit managers and PSAOs under this section may not disclose the identity of a specific health benefit plan or enrollee, the identity of a drug manufacturer, the prices charged for specific drugs or classes of drugs, or the amount of any rebates or fees provided for specific drugs or classes of drugs.
(6) On or before October 1st of each year, each health insurer shall submit a report to the board. The report must contain the following information for the previous two (2) calendar years:
(a) Names of the twenty-five (25) most frequently prescribed drugs across all plans;
(b) Names of the twenty-five (25) prescription drugs dispensed with the highest dollar spent in terms of gross revenue;
(c) Percent of increase in annual net spending for prescription drugs across all plans;
(d) Percent of increase in premiums which is attributable to prescription drugs across all plans;
(e) Percentage of specialty drugs with utilization management requirements across all plans; and
(f) Premium reductions attributable to specialty drug utilization management.
(7) A report submitted by a health insurer may not disclose the identity of a specific health benefit plan or the prices charged for specific prescription drugs or classes of prescription drugs.
(8) This section shall stand repealed on June 30, 2028.
SECTION 11. The following shall be codified as Section 73-21-167, Mississippi Code of 1972:
73-21-167. (1) The board shall develop a website to publish information the board receives under this chapter. The board shall make the website available on the board's website with a dedicated link prominently displayed on the home page, or by a separate, easily identifiable Internet address.
(2) Within sixty (60) days of receipt of reported information under this chapter, the board shall publish the reported information on the website developed under this section. The information the board publishes may not disclose or tend to disclose trade secrets, proprietary, commercial, financial or confidential information of any pharmacy, pharmacy benefit manager, PSAO, drug wholesaler or hospital.
(3) The board may adopt rules to implement this chapter. The board shall develop forms that must be used for reporting required under this chapter. The board may contract for services
to implement this chapter.
(4) A report received by the board shall not be subject to the provisions of the federal Freedom of Information Act or the Mississippi Public Records Act and shall not be released by the board unless subject to an order from a court of competent jurisdiction. The board shall destroy or delete or cause to be destroyed or deleted all such information thirty (30) days after the board determines that the information is no longer necessary or useful.
(5) This section shall stand repealed on June 30, 2028.
SECTION 12. The following shall be codified as Section 73-21-169, Mississippi Code of 1972:
73-21-169. (1) Pharmacy benefit managers and PSAOs shall also identify to the board any ownership affiliation of any kind with any pharmacy which, either directly or indirectly, through
one or more intermediaries:
(a) Has an investment or ownership interest in a pharmacy benefit manager or PSAO holding a certificate of authority;
(b) Shares common ownership with a pharmacy benefit manager or PSAO holding a certificate of authority in this state; or
(c) Has an investor or a holder of an ownership interest which is a pharmacy benefit manager or PSAO holding a certificate of authority issued in this state.
(2) A pharmacy benefit manager or PSAO shall report any change in information required by this act to the board in writing within sixty (60) days after the change occurs.
(3) This section shall stand repealed on June 30, 2028.
SECTION 13. This act shall take effect and be in force from and after July 1, 2025.