Bill Text: NY A02970 | 2019-2020 | General Assembly | Introduced
Bill Title: Implements the pharmacy benefit manager transparency act requiring disclosure and publishing of reports relating to pharmacy benefit managers.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A02970 Detail]
Download: New_York-2019-A02970-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2970 2019-2020 Regular Sessions IN ASSEMBLY January 28, 2019 ___________ Introduced by M. of A. ORTIZ -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to implementing the phar- macy benefit manager transparency act The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The insurance law is amended by adding a new article 6 to 2 read as follows: 3 ARTICLE 6 4 PHARMACY BENEFIT MANAGER TRANSPARENCY ACT 5 Section 601. Short title. 6 602. Definitions. 7 603. Responsibility to covered entities. 8 604. Pharmacy benefit manager transparency. 9 605. Report publication. 10 606. Compliance and enforcement. 11 607. Rulemaking authority. 12 § 601. Short title. This article shall be known and may be cited as 13 the "pharmacy benefit manager transparency act". 14 § 602. Definitions. For the purposes of this article, the following 15 definitions shall apply: 16 (1) "Covered entity" means a nonprofit hospital or medical service 17 organization, insurer, health coverage plan, or health maintenance 18 organization licensed in the state; a health program administered by the 19 superintendent or the state in the capacity of provider of health cover- 20 age; or an employer, labor union, or other group of persons organized in 21 the state that provides health coverage to covered individuals who are 22 employed or reside in the state. 23 (2) "Covered individual" means a member, participant, enrollee, 24 contract holder, or policy holder or beneficiary of a covered entity who 25 is provided health coverage by the covered entity. This includes a EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05277-01-9A. 2970 2 1 dependent or other person provided health coverage through a policy, 2 contract, or plan for a covered individual. 3 (3) "Pharmacy benefit manager" means an entity that contracts with or 4 is employed by a health benefit plan, state agency, insurer, managed 5 care organization, or other third-party payor for the administration or 6 management of prescription drug benefits provided by a covered entity 7 for the benefit of covered individuals. 8 (4) "Wholesale acquisition cost" means the list price for a 9 prescription drug, excluding any discounts, rebates, or reductions in 10 price, as reported in the most recent editions of the wholesale price 11 guides or other publications of drug pricing data a manufacturer 12 provides to wholesalers or distributors in the United States, as speci- 13 fied in 42 U.S.C. 23 § 1395w-3a(c)(6)(B). 14 § 603. Responsibility to covered entities. (1) A pharmacy benefit 15 manager shall exercise good faith and fair dealing in the performance of 16 its contractual obligations to a covered entity, and shall perform its 17 duties with care, skill, prudence, diligence, and professionalism. 18 (2) A pharmacy benefit manager shall notify a covered entity in writ- 19 ing of any activity, policy, practice, ownership interest, or affil- 20 iation of the pharmacy benefit manager that presents a conflict of 21 interest that interferes with the requirements imposed by this article. 22 § 604. Pharmacy benefit manager transparency. (1) Each pharmacy bene- 23 fit manager under contract with a covered entity shall submit to the 24 covered entity and to the superintendent no later than February first of 25 each year the following information for the immediately preceding calen- 26 dar year relative to such contract: 27 (a) The wholesale acquisition cost for each drug on its formulary and 28 the total number of prescriptions that were dispensed. 29 (b) The amount of rebates, discounts, and price concessions that the 30 pharmacy benefit manager received for each drug on its formulary. The 31 amount of rebates shall include any utilization discounts the pharmacy 32 benefit manager receives from a manufacturer. 33 (c) The amount of rebates, discounts, and price concessions described 34 in paragraph (b) of this subsection that were passed through to a 35 covered entity, and the amount that were retained by the pharmacy bene- 36 fit manager, for each drug on its formulary. 37 (d) The amount of any fee, administrative or otherwise, received from 38 a manufacturer. 39 (e) The nature, type, and amount of all other payments that the phar- 40 macy benefit manager receives, directly or indirectly, from a manufac- 41 turer in connection with a drug switch program, a formulary management 42 program, a mail service pharmacy, educational support, data sales 43 related to a covered individual, or any other function. 44 (f) The amount of any reimbursements the pharmacy benefit manager pays 45 to contracting pharmacies, and the negotiated price covered entities pay 46 the pharmacy benefit manager, for each drug on its formulary. 47 (g) Any other information as deemed necessary by the superintendent. 48 (2) The information disclosed pursuant to subsection one of this 49 section shall include all retail, mail order, specialty, and compounded 50 prescription products. 51 (3) Information submitted under this section shall be confidential and 52 shall not be disclosed to any person by the superintendent or the 53 covered entity receiving the information. Such information shall not be 54 deemed a public record of the superintendent. 55 § 605. Report publication. (1) In order to allow patients and employ- 56 ers to compare the ability of pharmacy benefit managers to negotiateA. 2970 3 1 rebates, discounts, and price concessions and the amount of such 2 rebates, discounts, and price concessions that are passed through to 3 plan sponsors, and to allow covered entities to evaluate the nature of 4 the relationship between pharmacy benefit managers and manufacturers and 5 the effectiveness of pharmacy benefit managers in reducing costs for 6 covered entities and their beneficiaries, no later than February first 7 of each year, the superintendent shall issue a report to be published on 8 the superintendent's website aggregating the information received by all 9 pharmacy benefit managers under this section for the preceding year. 10 (2) The superintendent shall ensure that the information described in 11 subsection one of this section is reported in a manner that prevents the 12 disclosure of the identity of a specific pharmacy benefit manager, a 13 covered entity, prices charged for prescription drugs or any associated 14 rebates, discounts or price concessions with respect to an individual 15 drug or an individual plan, or any information that identifies a product 16 or manufacturer. 17 (3) On or before February first of each year the superintendent shall 18 analyze the information submitted by pharmacy benefit managers pursuant 19 to this article and produce an additional report to be published on the 20 superintendent's website on the impact of pharmacy benefit managers on 21 the cost, administration, and availability of prescription drugs. 22 (4) The superintendent shall submit the report and any recommendations 23 for proposed legislation or further action by the state pursuant to the 24 report's findings to the temporary president of the senate, the speaker 25 of the assembly and the governor on or before February first of each 26 year. 27 § 606. Compliance and enforcement. (1) All contracts for pharmacy 28 benefit management entered into in this state or by a covered entity in 29 this state shall comply with the requirements of this article. 30 (2) The superintendent is responsible for the enforcement of this 31 article and may reasonably examine and investigate to ensure compliance 32 with the provisions herein. 33 (3) The superintendent shall adopt procedures for investigating 34 complaints of noncompliance with this article. If the superintendent 35 finds a pharmacy benefit manager has failed to comply with any of the 36 provisions of this article, the superintendent may, after notice and 37 opportunity for a hearing, impose one or more sanctions as deemed appro- 38 priate or necessary to bring non-complying entities into full compli- 39 ance, including, but not limited to: 40 (a) revoking or suspending a license issued to a pharmacy benefit 41 manager, or denying an application for a renewal of a license; 42 (b) imposing a period of probation best adapted to protect the public 43 health and safety and for any rehabilitation; 44 (c) imposing an administrative fine not to exceed two hundred fifty 45 dollars for each violation or instance of noncompliance; 46 (d) assessing costs to be paid by the pharmacy benefit manager; or 47 (e) imposing restrictions on the scope of operation of the pharmacy 48 benefit manager in the state. 49 (4) In addition to sanctions for noncompliance as described in 50 subsection three of this section, if a pharmacy benefit manager fails to 51 submit to the superintendent the information required under section six 52 hundred four of this article by the specified date, the superintendent 53 may impose against the pharmacy benefit manager an administrative penal- 54 ty of not more than two hundred fifty dollars for each day of such fail- 55 ure.A. 2970 4 1 (5) Any money collected, as administrative penalties or otherwise, 2 pursuant to this section must be used by the superintendent to cover the 3 costs of implementation and enforcement of this article. 4 § 607. Rulemaking authority. The superintendent shall promulgate and 5 adopt rules and regulations to effectuate the purposes and provisions of 6 this article. The rules and regulations shall be subject to review in 7 accordance with general rules of administrative rulemaking and review of 8 regulations in this state. 9 § 2. This act shall take effect immediately.