HCS HB 198 Wright, Dale Committee
HCS HB 198 -- INSURANCE COVERAGE OF PHARMACY SERVICES
SPONSOR: Wright
COMMITTEE ACTION: Voted "Do Pass with HCS" by the Standing Committee on Health and Mental Health Policy by a vote of 11 to 2. Voted "Do Pass" by the Standing Committee on Rules- Legislative Oversight by a vote of 6 to 1.
The following is a summary of the House Committee Substitute for HB 198.
This bill establishes requirements for insurance coverage of certain pharmacy services. This bill provides that a health carrier, pharmacy benefits manager, or agent of such entities are prohibited from imposing any penalty, impediment, differentiation, or limitation on:
(1) Participating providers for providing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains such drugs from a provider that is in the network;
(2) A person who is administered medically necessary clinician administered drugs regardless of whether the participating provider obtains such drugs from a provider that is in the network; or
(3) Any pharmacy, including any class B hospital pharmacy as defined in Section 338.220,RSMo, that is dispensing medically necessary clinician-administered drugs regardless of whether the participating provider obtains such drugs from a provider that is in the network.
This prohibition does not apply if the clinician-administered drug is not otherwise covered by the health carrier or pharmacy benefits manager.
This bill prevents health carriers, pharmacy benefits managers, or agents thereof from discriminating against a covered entity or pharmacy by doing any of the following:
(1) Reimbursing for a quantity of a certain drug in an amount less than it would pay to a similarly situated pharmacy, on the basis that is specified in the bill;
(2) Imposing terms or conditions on covered entities or pharmacies that differ from terms and conditions applied to other similarly situated pharmacies or entities that are not covered entities, on the basis that is specified in the bill;
(3) Interfering with a person's choice to receive a certain drug from a covered entity or pharmacy;
(4) Requiring a covered entity or pharmacy to identify certain drugs;
(5) Refusing to contract with a covered entity or pharmacy for reasons other than those that apply equally to entities that are not covered entities or similarly situated pharmacies, or on a certain basis;
(6) Denying the covered entity the ability to purchase drugs at 340B program pricing by substituting a rebate discount;
(7) Refusing to cover drugs purchased under the 340B pricing program; or
(8) Requiring a covered entity or pharmacy to reverse, resubmit, or clarify a 340B-drug pricing claim after the initial adjudication unless these actions are in the normal course of a pharmacy business, and not related to 340B drug pricing.
The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier, pharmacy benefits manager, or agent thereof that violates the above. The penalty shall not exceed a rate of $5000 per day.
The Director shall promulgate necessary rules and regulations to implement the provisions of this bill.
The following is a summary of the public testimony from the committee hearing. The testimony was based on the introduced version of the bill.
PROPONENTS: Supporters say that many clinics and patients are reliant on the 340B program, and that these allow for additional services such as extended walk-in and emergency services. For patients, there are not many additional avenues to help keep prescription costs down, and are typically at the whim of insurers who can be selective with covered treatments or drugs.
Testifying in person for the bill were Representative Wright; Mariah Hollabaugh, Citizens Memorial Hospital; Jodie Gregg; K. Scott Zweerink, University Health; and the Missouri Hospital Association.
OPPONENTS: Those who oppose the bill say that certain practices related to the 340B program, such as "white-bagging" drugs to be shipped directly to a patient for administration, are cost-saving measures; moreover, a pharmacy benefits manager is the only stakeholder within the insurance industry dedicated to reducing costs. There has been a growing lack of transparency with regard to oversight of the program in some hospitals, and this legislation may, through a variety of means, raise costs for prescription drugs.
Testifying in person against the bill were Blue Cross Blue Shield; Americas Health Insurance Plans; Missouri Insurance Coalition; St. Louis Area Business Health Coalition; and the Pharmaceutical Care Management Association (PCMA).
OTHERS: Others testifying on the bill say that there are discrepancies with payments pertaining to the practices of "white-bagging" and "brown-bagging", with opposing viewpoints shared on the benefiting stakeholder: hospitals or insurance companies. There are some notable concerns with white-bagging, such as the spoiling of certain drugs or high costs, and that for many federally qualified health centers (FQHCs), the 340B program has been indispensable.
Testifying in person on the bill was PhRMA.
Written testimony has been submitted for this bill. The full written testimony and witnesses testifying online can be found under Testimony on the bill page on the House website.