HCS/HBs 2045 & 2316 - This act requires a health carrier or managed care plan that provides prescription drug coverage in the state to offer medication synchronization services. A health carrier or managed care plan that provides prescription drug coverage shall not charge any amount in excess of the otherwise applicable co-payment for dispensing a prescription drug in a quantity that is less than the prescribed amount and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met. The act also requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost (MAC) list of drugs or modify MAC pricing within seven days if the drugs do not meet the standards as provided in the act.
A PBM shall reimburse pharmacies for drugs subject to MAC pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from at least one manufacturer and is generally available for purchase from national or regional wholesalers.
All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list.
Provisions of this act are identical to provisions in CCS#2/HCS/SS/SB 608 (2016), CCS/HCS/SB 635 (2016), CCS/HCS/SS/SCS/SBs 865 & 866 (2016), substantially similar to provisions in SCS/SB 908 (2016), SB 910 (2016), and HCS/SB 458 (2015), and similar to provisions in SB 325 (2015), SB 528 (2015), HB 198 (2015), and SB 895 (2014).
SARAH HASKINS