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Bill > SB0008


IN SB0008

IN SB0008
Prescription drug rebates and pricing.


summary

Introduced
01/09/2023
In Committee
04/06/2023
Crossed Over
02/24/2023
Passed
04/12/2023
Dead
Signed/Enacted/Adopted
05/04/2023

Introduced Session

2023 Regular Session

Bill Summary

Prescription drug rebates and pricing. Requires a pharmacy benefit manager to provide a report to the department of insurance at least every six months. Provides that the report must include the: (1) overall aggregate amount charged to a health plan for all pharmaceutical claims processed by the pharmacy benefit manager; and (2) overall aggregate amount paid to pharmacies for claims processed by the pharmacy benefit manager. Requires that, for individual health insurance coverage, the defined cost sharing for a prescription drug be calculated at the point of sale and based on a price that is reduced by an amount equal to at least 85% of all rebates in connection with the dispensing or administration of the prescription drug. Requires that, for group health insurance coverage, an insurer: (1) pass through to a plan sponsor 100% of all rebates concerning the dispensing or administration of prescription drugs to the covered individuals of the plan sponsor; (2) provide a plan sponsor, at the time of contracting, the option of calculating defined cost sharing for covered individuals of the plan sponsor at the point of sale based on a price that is reduced by some or all of the rebates received concerning the dispensing or administration of the prescription drug; and (3) disclose specified information to the plan sponsor. Allows the department of insurance to enforce the provisions and impose a civil penalty.

AI Summary

This bill requires pharmacy benefit managers to provide regular reports to the state's Department of Insurance on the aggregate amounts charged to health plans and paid to pharmacies. For individual health insurance coverage, the bill mandates that the defined cost-sharing for a prescription drug be calculated at the point of sale and based on a price reduced by at least 85% of all related rebates. For group health insurance coverage, the bill requires insurers to pass through 100% of rebates to the plan sponsor and provide the option to calculate defined cost-sharing at the point of sale based on a price reduced by some or all of the rebates. The bill also allows the Department of Insurance to enforce these provisions and impose civil penalties.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (11)

Last Action

Public Law 166 (on 05/04/2023)

bill text


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