State SealARIZONA HOUSE OF REPRESENTATIVES

 

HB 2285: pharmacy benefit managers; pharmacy benefits

PRIME SPONSOR: Representative Cobb, LD 5

BILL STATUS: Caucus & COW

                                HHS: DPA 9-0-0-0

 

 

Overview

Allows for 90-day fills and delivery of medications and makes the sources used to determine maximum allowable costs available annually to each network pharmacy.

History

Title 20 contains laws relating to the transaction of insurance. Chapter 25 of the title outlines pharmacy benefits.  

Provisions

1.       Requires a pharmacy benefit manager (PBM) to:

a.       Update every seven business days the price and drug changes for each list that the PBM maintains.

b.       Make available the sources used to determine maximum allowable cost pricing to each network pharmacy at the beginning of the term of a contract, on renewal of a contract, and at least once annually.

c.        c. Establish a process which a network pharmacy may appeal its reimbursement for a drug subject to the maximum allowable cost price.

d.       d. Allow a contracted pharmacy service administrative organization to file an appeal of a drug on behalf of their contracted pharmacies. (Sec. 2)

2.       Establishes that this section applies to all new and existing contracts between a PBM and a licensed pharmacy on January 1, 2020. (Sec. 2)

3.       Establishes that a plan sponsor or a PBM may not prohibit a retail pharmacy in its network from dispensing a 90-day fill of a prescription medication if:

a.       A 90-day fill of that medication is allowed by the plan sponsor's pharmacy benefit at any retail pharmacy and the retail pharmacy agrees to the reimbursement rate and the contractual requirements required by the plan sponsor or a PBM.

b.       A 90-day fill is required for that medication by the plan sponsor's pharmacy benefit and the retail pharmacy agrees to the reimbursement rate and the contractual requirements required by the plan sponsor or a PBM. (Sec. 4)

4.       Stipulates that this section on 90-day fills does not apply to dispensing Schedule II or III controlled substances. (Sec. 4)

5.       Provides that a plan sponsor or a PBM may not prohibit a retail pharmacy from offering as an additional service of a pharmacy:

a.       Limited delivery of prescription drugs by mail or common carrier to a patient.

b.       Hand delivery of prescription drugs to a patient by an employee or contractor of the pharmacy. (Sec. 4)

6.       Prohibits a pharmacy from charging the plan sponsors or a PBM for the delivery of a prescription to a patient unless specifically agreed on by the plan sponsor or a PBM. (Sec. 4)

7.       Requires a pharmacy to disclose to the patient any fee that will be charged to the patient for delivery of a prescription drug to the patient, including that the fee may not be reimbursable by the plan sponsor or PBM.  (Sec. 4)

8.       States that the delivery of prescription drugs does not apply to Arizona Health Care Cost Containment System (AHCCCS). (Sec. 4)

9.       Defines terms.  (Sec. 1,3)

10.   Makes technical and conforming changes. (Sec. 1, 3)

Amendments

Committee on Health & Human Services

1.       Modifies the definition of  list and maximum allowable cost. (Sec. 1)

2.       Stipulates that the section on 90-day drug fills does not apply to AHCCCS. (Sec. 4)

 

 

 

 

 

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Fifty-fourth Legislature                               HB 2285

First Regular Session                    Version 2: Caucus & COW

 

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