| Last Action | 04/05/24: signed by Governor (Acts Ch. 104) |
|---|---|
| Title | AN ACT relating to patient access to pharmacy benefits. |
| Bill Documents |
Acts Chapter 104
Current/Final Introduced |
| Fiscal Impact Statements |
Actuarial Analysis
Local Mandate Additional Fiscal Impact Statements Exist |
| Bill Request Number | 1333 |
| Sponsors | M. Wise, S. Meredith, K. Berg, G. Boswell, M. Deneen, D. Douglas, G. Elkins, S. Funke Frommeyer, R. Girdler, J. Higdon, J. Howell, R. Mills, G. Neal, A. Southworth, B. Storm, R. Thomas, L. Tichenor, R. Webb, S. West, P. Wheeler, M. Wilson, D. Yates |
| Summary of Enacted Version | Amends KRS 18A.2254 to require that the state employee health plan and state agencies comply with certain pharmacy-related insurance laws; creates new sections of Subtitle 17A of KRS Chapter 304 to define terms for pharmacy-related insurance practices, to require that insurers, pharmacy benefit managers, and other pharmacy benefits administrators establish reasonably adequate and accessible pharmacy networks, to require the filing of an annual report, to require that the insurance commissioner review pharmacy networks, to provide that information and data acquired by the Department of Insurance be considered proprietary and not subject to disclosure under open records laws, to establish requirements for certain contracts between a pharmacy or pharmacist and an insurer, a pharmacy benefit manager, or any other pharmacy benefits administrator, to establish prohibited conduct and requirements for certain pharmacy-related insurance practices, and to establish a complaint process for insureds, pharmacies, and pharmacists impacted by a violation of certain pharmacy-related insurance laws; creates a new section of Subtitle 99 of KRS Chapter 304 to authorize the insurance commissioner to order reimbursement to persons who incurred a monetary loss as a result of a violation of certain pharmacy-related insurance laws; amends KRS 304.9-053 to require certain filings; amends KRS 304.9-054 to establish requirements for pharmacy benefit manager licensure; amends KRS 304.9-055 to require that the insurance commissioner promulgate certain administrative regulations relating to pharmacy benefit managers; amends KRS 304.14-120 to require that the insurance commissioner review certain health plan filings; amends KRS 304.17A-712 to conform; amends KRS 304.17C-125 to apply certain pharmacy-related insurance laws to limited health service benefit plans, including limited health service contracts; amends KRS 304.38A-115 to apply certain pharmacy-related insurance laws to limited health service organizations; repeals KRS 304.38A-120, relating to assignment of certain benefits under limited health service organization plans, to consolidate provisions; creates a new section of KRS Chapter 315 to require reporting by ambulatory pharmacies to the Kentucky Board of Pharmacy; amends KRS 367.828 to establish certain requirements for health discount plans relating to prescription drugs; makes technical corrections to existing statutes throughout; applies various sections to contracts issued or renewed on or after January 1, 2025; and requires the insurance commissioner and the Kentucky Board of Pharmacy to promulgate implementing administrative regulations by certain dates; EFFECTIVE, in part, January 1, 2025. |
| Summary of Original Version | Create new sections of Subtitle 17A of KRS Chapter 304 to define terms for pharmacy-related insurance practices; require insurers, pharmacy benefit managers, and other pharmacy benefits administrators to establish reasonably adequate and accessible pharmacy networks; require the filing of an annual report; require the insurance commissioner to review pharmacy networks; provide that 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 relating to open records; establish requirements for certain contracts between a pharmacy or pharmacist and an insurer, a pharmacy benefit manager, or any other pharmacy benefits administrator; establish prohibited conduct and requirements for certain pharmacy-related insurance practices; establish a complaint process for insureds, pharmacies, and pharmacists impacted by a violation of certain pharmacy-related insurance laws; create a new section of Subtitle 99 of KRS Chapter 304 to authorize the insurance commissioner to order reimbursement to persons who incurred a monetary loss as a result of a violation of certain pharmacy-related insurance laws; amend KRS 304.9-053 to require certain filings; amend KRS 304.9-054 to establish requirements for pharmacy benefit manager licensure; amend KRS 304.9-055 to permit the insurance commissioner to promulgate administrative regulations relating to pharmacy benefit managers; amend KRS 304.14-120 to require the insurance commissioner to review certain health plans; amend KRS 304.17A-712 to conform; amend KRS 304.17C-125 to apply certain pharmacy-related insurance laws to limited health service benefit plans, including limited health service contracts; amend KRS 304.38A-115 to apply certain pharmacy-related insurance laws to limited health service organizations; create a new section of KRS Chapter 18A to require the state employee health plan and state agencies to comply with certain pharmacy-related insurance laws; amend KRS 367.828 to establish certain requirements for health discount plans relating to prescription drugs; make technical corrections; repeal KRS 304.38A-120, relating to assignment of certain benefits under limited health service organization plans, to consolidate provisions; apply various sections to contracts issued or renewed on or after January 1, 2025; require the insurance commissioner to promulgate administrative regulations to implement this Act on or before January 1, 2025; EFFECTIVE, in part, January 1, 2025. |
| Index Headings of Original Version |
Drugs and Medicines - Pharmacy or pharmacist services, trade practice requirements Effective Dates, Delayed - Pharmacy or pharmacist services, trade practice requirements, January 1, 2025 Federal Laws and Regulations - Pharmacy-related trade practices, compliance with federal law Insurance, Health - Pharmacy or pharmacist services, coverage requirements Insurance, Health - Pharmacy-related trade practices, prohibited conduct Insurance, Health - Provider contracts, pharmacy or pharmacist services, requirements Pharmacists - Health plan provider contracts, pharmacy or pharmacist services, requirements State Employees - Health plan contracts, pharmacy or pharmacist services, requirements State Employees - Health plan, pharmacy or pharmacist services, coverage requirements Technical Corrections - Insurance policy filing requirements Technical Corrections - Pharmacy benefit managers, licensure requirements Administrative Regulations and Proceedings - Department of Insurance, pharmacy benefit managers, regulation Consumer Affairs - Pharmacy or pharmacist services, trade practice requirements Reports Mandated - Department of Insurance, network adequacy, pharmacy benefits Actuarial Analysis - Pharmacy or pharmacist services, coverage requirements Local Mandate - Pharmacy or pharmacist services, coverage requirements |
| Jump to Proposed Amendments |
Senate Committee Substitute 1 with Fiscal Impact Statements Senate Floor Amendment 1 |
| Votes | Vote History |
| 02/08/24 |
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| 02/12/24 |
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| 03/06/24 |
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| 03/11/24 |
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| 03/14/24 |
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| 03/22/24 |
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| 03/25/24 |
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| 03/26/24 |
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| 03/27/24 |
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| 03/28/24 |
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| 04/05/24 |
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| Amendment | Senate Committee Substitute 1 |
|---|---|
| Fiscal Impact Statements |
Actuarial Analysis to Senate Committee Substitute 1
Health Mandate to Senate Committee Substitute 1 Local Mandate to Senate Committee Substitute 1 |
| Summary | Retain original provisions, except exempt Medicare Part D plans and student health insurance from the definition of "health plan"; define "ambulatory pharmacy"; amend minimum dispensing fee requirements; require the insurance commissioner to make a determination based on a study conducted every two years; delete prohibition against requiring or incentivizing the use of a mail-order pharmacy to furnish prescription drugs for subsequent administration in a hospital, clinic, pharmacy, or infusion center; amend requirements for the insurance commissioner's review of health plans; create a new section of KRS Chapter 315 to require reporting by ambulatory pharmacies to the Kentucky Board of Pharmacy; establish requirements for the collection, use, and sharing of data; require the Department of Insurance and the Kentucky Board of Pharmacy to consult, share data, and promulgate administrative regulations; require administrative regulations to be promulgated by certain dates. |
| Index Headings |
Health Benefit Mandate - Provider contracts pharmacy or pharmacist services, requirements Drugs and Medicines - Pharmacy or pharmacist services, trade practice requirements Federal Laws and Regulations - Pharmacy-related trade practices, compliance with federal law Insurance, Health - Pharmacy-related trade practices, prohibited conduct Insurance, Health - Provider contracts, pharmacy or pharmacist services, requirements Pharmacists - Health plan provider contracts, pharmacy or pharmacist services, requirements State Agencies - Department of Insurance, average ambulatory pharmacy dispensing cost, study State Agencies - Kentucky Board of Pharmacy, ambulatory pharmacies, data collection Technical Corrections - SCS 1 to SB 188 Administrative Regulations and Proceedings - Department of Insurance, average ambulatory pharmacy dispensing fee, data collection Administrative Regulations and Proceedings - Kentucky Board of Pharmacy, data collection, ambulatory pharmacies Consumer Affairs - Pharmacy or pharmacist services, trade practice requirements Actuarial Analysis - Kentucky Board of Pharmacy, data collection, ambulatory pharmacies Local Mandate - Provider contracts, pharmacy or pharmacist services, requirements |
| Amendment | Senate Floor Amendment 1 |
|---|---|
| Sponsor | M. Wise |
| Summary | Delete 30 minutes distance standard as a network adequacy threshold; amend minimum dispensing fee requirement to exempt mail-order pharmaceutical distributors; delete and reinsert, as an amendment to KRS 18A.2254, application of pharmacy trade practice requirements to state employee health plan; make conforming amendments. |
| Index Headings |
State Employees - Health plan contracts, pharmacy or pharmacist services, requirements State Employees - Health plan, pharmacy or pharmacist services, coverage requirements Drugs and Medicines - Professional dispensing fee, prescription drugs and other services Insurance, Health - Pharmacy-related trade practices, prohibited conduct Pharmacists - Professional dispensing fee, prescription drugs and other services |
Last updated: 9/26/2024 1:37 PM (EDT)