Title: Amends Previous Prescription Drug Cost Laws
Title: Amends Previous Prescription Drug Cost Laws
Vote to pass a bill that amends certain prescription drug cost laws.
Defines “Cost-sharing” as the cost to an individual insured under a health benefit plan according to any of the following, including, but not limited to (Sec. 1):
Coverage limit or copayment;
Coinsurance or deductible; or
Any other out-of-pocket expense requirements imposed by the plan.
Prohibits a health plan issuer, pharmacy benefit manager, or any other administrator to require cost-sharing in an amount that exceeds either of the following, including, but not limited to (Sec. 1):
The amount an individual would pay for a drug purchased without coverage under a health benefit plan; and
The net reimbursement paid to the pharmacy for the prescription drug by the health plan issuer, pharmacy benefit manager,or administrator.
Prohibits a health plan issuer, pharmacy benefit manager, or administrator from retroactively adjusting a pharmacy claim for reimbursement for a prescription drug, unless under the following conditions, including, but not limited to (Sec. 1):
A pharmacy audit; or
A technical billing error.
Specifies that a health plan issuer, pharmacy benefit manager, or administrator from charging a fee related to a claim unless the amount of the fee can be determined at the time of claim adjudication (Sec. 1).
Specifies that the Department of Insurance will create a web form that consumers can use to submit complaints related to violations under this act (Sec. 1).
Requires a pharmacist, pharmacy intern, or terminal distributor of dangerous drugs who has information indicating that the cost-sharing amount charged by an individual patient's health benefit plan exceeds the amount that may otherwise be charged to notify the individual patient about this information and not charge a higher amount (Sec. 1).
Title: Amends Previous Prescription Drug Cost Laws