| Last Action | 04/05/24: signed by Governor |
|---|---|
| Title | AN ACT relating to patient access to pharmacy benefits. |
| Bill Documents |
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 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: 4/22/2024 3:57 PM (EDT)