340B DRUG PRICING PROGRAM (Section 376.414)

Under this act, no health carrier or pharmacy benefits manager (PBM) shall discriminate against a covered entity or a specified pharmacy, as such terms are defined in the act, by:

• Reimbursing a covered entity or specified pharmacy for a quantity of a 340B drug, as defined in the act, in an amount less than the carrier or PBM would pay to any other similarly situated pharmacy for such quantity of the drug on the basis that the entity or pharmacy is a covered entity or specified pharmacy, as defined in the act, or that the entity or pharmacy dispenses 340B drugs. (Section 376.414.2(1));

• Imposing any terms or conditions on covered entities or specified pharmacies which differ from the terms or conditions applicable to other similarly situated pharmacies on the basis that the entity or pharmacy is a covered entity or specified pharmacy or dispenses 340B drugs, including but not limited to certain terms and conditions described in the act. (Section 376.414.2(2));

• Interfering with an individual's choice to receive a 340B drug from a covered entity or specified pharmacy. (Section 376.414.2(3)); or

• Refusing to contract with a covered entity or specified pharmacy for reasons other than those that apply equally to entities or pharmacies that are not covered entities or specified pharmacies, or on the basis that the entity or pharmacy is a covered entity or specified pharmacy, or on the basis that the entity or pharmacy is described as a covered entity under provisions of federal law. (Section 376.414.2(4)).

The Director of the Department of Commerce and Insurance shall impose a civil penalty on any PBM violating certain provisions of the act, not to exceed $5,000 per violation per day. (Section 376.414.3).

These provisions are similar to SB 426 (2023), provisions in SB 402 (2023), SB 679 (2023), HB 197 (2023), HB 198 (2023), HB 1330 (2023), SB 921 (2022), provisions in HCS/HB 1677 (2022), provisions in SB 1129 (2022), provisions in HB 2305 (2022), provisions in SB 971 (2020), provisions in HCS/HB 2412 (2020), provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), provisions in HB 1910 (2020), provisions in SB 413 (2019), and provisions in HB 1165 (2019).

CALCULATION OF COST-SHARING REQUIREMENTS (Section 376.448)

This act provides that when calculating an enrollee's overall contribution to an out-of-pocket max or any cost-sharing requirement under a health benefit plan, a health carrier or pharmacy benefits manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee for any medication for which a generic substitute is not available.

These provisions are similar to SB 269 (2023) and SB 1031 (2022).

ERIC VANDER WEERD