House Bill 398

Actions
Last Action 02/10/20: to Banking & Insurance (H)
Title AN ACT relating to pharmacy or pharmacist services.
Bill Documents Introduced
Fiscal Impact Statement Health Mandate
Bill Request Number 42
Sponsors S. Sheldon, D. Bentley, K. Banta, J. Blanton, A. Bowling, R. Brenda, R. Bridges, D. Frazier, C. Freeland, C. Fugate, R. Goforth, S. Heavrin, R. Huff, T. Huff, M. Koch, D. Lewis, S. Lewis, B. McCool, M. Meredith, J. Nemes, P. Pratt, B. Reed, S. Riley, S. Rudy, S. Santoro, N. Tate, W. Thomas, R. Webber, L. Yates
Summary of Original Version Create a new section of Subtitle 17A, KRS Chapter 304 to define "health plan," "insurer," "pharmacy benefit manager," and "pharmacy or pharmacist services"; provide exceptions for federal laws that conflict with legislation; require Cabinet for Health and Family Services to take any steps necessary to effectuate legislation; amend KRS 304.17A-164 to define "pharmacy affiliate"; prohibit insurers, pharmacy benefit managers, and other administrators of pharmacy benefits from imposing certain requirements on patients covered under a health plan; create new sections of KRS 304.17A-165 to 304.17A-166 to require insurers, pharmacy benefit managers, and other administrators of pharmacy benefits to establish reasonably adequate and accessible pharmacy networks; require insurers, pharmacy benefit managers, and other administrators of pharmacy benefits to file an annual report describing their pharmacy networks with the insurance commissioner; require the insurance commissioner to review each report to ensure networks are reasonably adequate and accessible; provide that the insurance commissioner may review and approve the compensation programs for pharmacy or pharmacist services of insurers, pharmacy benefit managers, and other administrators of pharmacy benefits; provide that all information and data acquired by the Department of Insurance shall be considered proprietary and not subject to disclosure under KRS 61.870 to 61.884; define "actual overpayment"; establish requirements for contracts between a pharmacy or pharmacist and an insurer, pharmacy benefit manager, or other administrator of pharmacy benefits for the provision of pharmacy or pharmacist services in this state; require contracts to prohibit insurers, pharmacy benefit managers, and other administrators of pharmacy benefits from engaging in certain payment and other practices relating to the provision of pharmacy or pharmacist services; establish certain requirements for insurers, pharmacy benefit managers, and other administrators of pharmacy benefits receiving offers or applications to contract for the provision of pharmacy or pharmacist services in this state; define "rebate" and "spread pricing"; establish certain requirements for insurers contracting with pharmacy benefit managers and other administrators of pharmacy benefits; prohibit pharmacy benefit managers and other administrators of pharmacy benefits from engaging in spread pricing in this state; require pharmacy benefit managers and other administrators of pharmacy benefits to report to the insurance commissioner, on a quarterly basis, rebates and amounts paid for pharmacy or pharmacist services; provide that certain information and data acquired by the Department of Insurance shall be considered proprietary and not subject to disclosure under KRS 61.870 to 61.884; provide that the insurance commissioner may promulgate administrative regulations establishing prohibited practices of pharmacy benefit managers and other administrators of pharmacy benefits; create a new section of Subtitle 17A, KRS Chapter 304, to establish a Pharmacy Benefits Management Advisory Council; establish duties, membership, and procedural requirements for the council; amend KRS 304.17A-005 to add pharmacy to the definition of "health care provider"; amend KRS 304.17A-708, 304.17A-712, and 304.17A-714 to conform; amend KRS 304.17A-515 to establish network adequacy requirements for pharmacy services covered under a managed care plan; create a new section of Subtitle 17C, KRS Chapter 304, and amend KRS 304.17C-040 to apply provisions of legislation to limited health service benefit plans, including limited health service contracts; create a new section of Subtitle 38A, KRS Chapter 304, to apply provisions of legislation to limited health service organizations; amend KRS 205.522 and KRS 205.532 to require Medicaid entities to comply with provisions of legislation; amend KRS 205.647 to establish compliance and reporting requirements for pharmacy benefit managers administering Medicaid benefits; to establish requirement that Medicaid managed care organizations and pharmacy benefit managers shall not require pharmacies to participate with a Medicaid program in order to participate with non-Medicaid programs; to establish civil penalties for failure to comply with section; amend KRS 18A.2259 and 18A.225 to require the state employee health plan to comply with provisions of legislation; provide that provisions of this Act shall be severable; EFFECTIVE January 1, 2021.
Index Headings of Original Version Health Benefit Mandate - Pharmacy or pharmacist services, required coverage for
Drugs and Medicines - Pharmacy or pharmacist services, requirements for
Effective Dates, Delayed - Pharmacy or pharmacist services, requirements for, January 1, 2021
Federal Laws and Regulations - Federal law, pharmacy or pharmacist services, exemptions for
Insurance, Health - Pharmacy benefit contracts, requirements for
Insurance, Health - Pharmacy or pharmacist services, covered persons, contracts for provision of
Insurance, Health - Pharmacy or pharmacist services, required coverage for
Pharmacists - Pharmacy or pharmacist services, covered persons, contracts for provision of
State Agencies - Department of Insurance, Pharmacy Benefits Management Advisory Council
State Agencies - Department of Insurance, pharmacy or pharmacist services, covered persons, regulation of
State Employees - Pharmacy benefits contracts, requirements for
State Employees - Pharmacy or pharmacist services, covered persons, contracts for provision of
State Employees - Pharmacy or pharmacist services, required coverage for
Medicaid - Pharmacy benefits contracts, requirements for
Medicaid - Pharmacy or pharmacist services, covered persons, contracts for provision of
Medicaid - Pharmacy or pharmacist services, required Medicaid coverage for
Administrative Regulations and Proceedings - Department of Insurance, pharmacy benefit managers, regulation of
Reports Mandated - Department of Insurance, administration of pharmacy benefits, reports for

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02/07/20
  • introduced in House
02/10/20
  • to Banking & Insurance (H)


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