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2019MedicaidReformLegislationLastUpdated:October18,2019
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USCongress
TitleMedi-Cal:hypertensionmedicationmanagementservices.
DescriptionSB446,asamended,Stone.Medi-Cal:hypertensionmedicationmanagementservices.ExistinglawprovidesfortheMedi-Calprogram,whichisadministeredbytheStateDepartmentofHealthCareServices,underwhichqualifiedlow-incomeindividualsreceivehealthcareservices.TheMedi-Calprogramis,inpart,governedandfundedbyfederalMedicaidprogramprovisions.ExistinglawprovidesforascheduleofbenefitsundertheMedi-Calprogram,whichincludespharmacistservices,subjecttoapprovalbythefederalCentersforMedicareandMedicaidServices.Underexistinglaw,coveredpharmacistservicesinclude,butarenotlimitedto,furnishingtravelmedications,initiatingandadministeringimmunizations,providingtobaccocessationcounseling,andfurnishingnicotinereplacementtherapy.ThisbillwouldadditionallyprovidethathypertensionmedicationmanagementservicesareacoveredpharmacistserviceundertheMedi-Calprogram,asspecified.
PrimarySponsorsJeffStone
BillSummary:LasteditedbyzAllieJoShipmanatMar8,2019,1:41AMThisbillprovidesthathypertensionmedicationmanagementservicesareacoveredpharmacistserviceundertheMedi-Calprogram,asspecified.
Labels: CompensationforServices
State
CABillNumber
SB446LastAction
May16HearingHeldInCommitteeAndUnderSubmission20190516
Status
FailedsinediePosition
Support
TitlePharmacybenefitmanagement:PrescriptionAcquisitionandAdjudicationAgency.
DescriptionSB642,asamended,Stone.Pharmacybenefitmanagement:PrescriptionAcquisitionandAdjudicationAgency.ExistinglawprovidesfortheregulationofhealthcareserviceplansbytheDepartmentofManagedHealthCare.Awillfulviolationofthoseprovisionsisacrime.Existinglaw,onandafterJanuary1,2020,prohibitsahealthcareserviceplanfromincludinginacontractwithapharmacyprovideroritscontractingagentaprovisionthatprohibitstheproviderfrominformingapatientofalesscostlyalternativetoaprescribedmedication.Existinglawrequiresahealthcareserviceplanthatcontractswithapharmacybenefitmanagerformanagementofanyorallofitsprescriptiondrugcoveragetorequirethepharmacybenefitmanagertocomplywithspecifiedprovisions,registerwiththedepartmentpursuanttothoseprovisions,andexercisegoodfaithandfairdealingintheperformanceofitscontractualdutiestoahealthcareserviceplan.ExistinglawprovidesfortheregulationofhealthinsurersbytheDepartmentofInsurance.Thisbillwould,onandafterJuly1,2021,prohibitahealthcareserviceplanorahealthinsurerfromenteringinto,renewing,orextendingacontractforpharmacybenefitmanagerservices,asdefined.Becauseaviolationofthisprohibitionbyahealthcareserviceplanwouldbeacrime,thisbillwouldimposeastate-mandatedlocalprogram.ThisbillwouldcreatethePrescriptionAcquisitionandAdjudicationAgency,andwouldcreateanadvisoryboardforthatagency,asspecified.Thebillwouldrequireadivisionoftheagencytoofferpharmacybenefitmanagerservicestohealthcareserviceplansandhealthinsurers,includingadjudicatedclaimprocessing,negotiationsforpharmaceuticaldiscounts,andthecreationofformulariesforeachplanorinsurer,asspecified.Thisbillwouldadditionallyrequireaseparatedivisionoftheagencytonegotiatewithpharmaceuticalmanufacturersfordiscountsandrebatesforthoseplansorinsurers,andwouldrequiretheagencytodevelopaclosedbiddingprocessforthosenegotiations.Thebillwouldrequireanagreementbetweentheagencyandahealthcareserviceplanorhealthinsurertoincludeprovisionsgranting10%ofanyrebateorofthedifferencebetweenthemarketvalueandthepricenegotiatedbytheagency,or100%oftherebateordifferenceiftheagreementiswithaMedi-Calmanagedcareplan,tobepaidtotheagency,anddepositedintothePharmaceuticalDiscountFund,andwouldmakethosefundsavailable,uponappropriationbytheLegislature,totheagencytofunditscostsorforotherprogramstolowerhealthcarecostsinthestate.Existingconstitutionalprovisionsrequirethatastatutethatlimitstherigh...(clickbilllinktoseemore).
PrimarySponsorsJeffStone
State
CABillNumber
SB642LastAction
ReReferredToComOnHealth20190424Status
FailedsinediePosition
None
TitleStateEmployees'GroupInsuranceProgram
DescriptionRequiresprocurementsofcertaincontractstobeconductedsimultaneouslybeginninginspecifiedyear;providesrequirementsforsuchcontracts;requiresHMOstobenegotiatedonregionalorstatewidebasis;authorizesinternationalprescriptionservicestobeincludedinstategroupinsuranceprogram;requiresdepartmenttoofferinternationalprescriptionservices;requiresDMStousevaryingplan&networkdesignsinprescriptiondrugprogram;requiresdepartmenttoimplementformularymanagementcost-savingmeasures;providesrequirementsforsuchmeasures;requiresdepartmenttoenterintocontractswithbenefitsconsultingcompanies;ch.99-255,LawsofFlorida;removesprovisionthatprohibitsdepartmentfromimplementingrestrictedprescriptiondrugformularyorpriorauthorizationprograminprescriptiondrugprogram.
PrimarySponsorsM.L.Magar,HouseCommitteeonAppropriations
TitleRelatingToTheStateBudget.
DescriptionAppropriatesfundsfortheoperatingbudgetoftheExecutiveBranchforfiscalyears20192020and20202021.(HB116CD1)
PrimarySponsorsSylviaLuke
State
FLBillNumber
HB5009LastAction
DiedInGovernmentalOversightAndAccountabilityCompanionBillSPassedSeeCsHb1113Ch2019100Sb2500Ch201911520190503
Status
FailedPosition
None
State
HIBillNumber
HB116LastAction
Act11306212019GovMsgNo121520190625
Status
EnactedPosition
None
TitleInsCode-BirthControl
DescriptionAmendstheDepartmentofPublicHealthPowersandDutiesLawoftheCivilAdministrativeCodeofIllinois.ProvidesthattheDirectorofPublicHealth,ifaphysicianlicensedtopracticemedicineinallitsbranchesinIllinois,shallestablishastandingordercompletewiththeissuanceofaprescriptionforahormonalcontraceptiveinaccordancewiththerequirementsoftheprovisions.ProvidesthatiftheDirectorisnotaphysicianlicensedtopracticemedicineinallitsbranchesinIllinois,theMedicalDirectoroftheDepartmentofPublicHealthshallestablishthestandingorder.AmendstheIllinoisInsuranceCode.Requiresagrouporindividualpolicyofaccidentandhealthinsuranceormanagedcareplantoprovidecoverageforpatientcareservicesprovidedbyapharmacist.MakesconformingchangesintheStateEmployeesGroupInsuranceActof1971,theCountiesCode,theIllinoisMunicipalCode,andtheSchoolCode.AmendsthePharmacyPracticeAct.Providesthatthedefinitionof"practiceofpharmacy"includesthedispensingofhormonalcontraceptivespursuanttothestandingorderunderprovisionsoftheDepartmentofPublicHealthPowersandDutiesLawoftheCivilAdministrativeCodeofIllinois.AmendstheIllinoisPublicAidCode.Requiresthemedicalassistanceprogramtocoverpatientcareservicesprovidedbyapharmacistforhormonalcontraceptivesassessmentandconsultation.EffectiveJanuary1,2020.
PrimarySponsorsAnneStava-Murray,MichelleMussman,JonathanCarroll
BillSummary:LasteditedbyzAllieJoShipmanatFeb6,2019,5:30PMThisbillchangesthedefinitionofthepracticeofpharmacytoallowapharmacisttodispensea12-monthsupplyofhormonalcontraceptivestoapatientpursuanttoastandingorder.ItalsorequirespharmaciststocompleteanACPE-accreditedtrainingprogrampriortodispensingunderthestandingorder.Thisbillrequirescertainhealthinsuranceplanstoprovidecoverageforpatientcareservicesprovidedbyapharmacistforhormonalcontraceptivesassessmentandconsultation.ItrequiresthestateMedicaidprogram(bothFFSandmanagedcare)tocovertheseservicesatarateofreimbursementof85%ofthephysicianfeeschedule.
Labels: BirthControl CompensationforServices
ScopeofPractice
State
ILBillNumber
HB1442LastAction
AddedCoSponsorRepLindseyLapointe20190807
Status
InHousePosition
Support
TitleInsCode-BirthControl
DescriptionAmendstheDepartmentofPublicHealthPowersandDutiesLawoftheCivilAdministrativeCodeofIllinois.ProvidesthattheDirectorofPublicHealth,ifaphysicianlicensedtopracticemedicineinallitsbranchesinIllinois,shallestablishastandingordercompletewiththeissuanceofaprescriptionforahormonalcontraceptiveinaccordancewiththerequirementsoftheprovisions.ProvidesthatiftheDirectorisnotaphysicianlicensedtopracticemedicineinallitsbranchesinIllinois,theMedicalDirectoroftheDepartmentofPublicHealthshallestablishthestandingorder.Providesthatapharmacistmaydispensea12-monthsupplyofhormonalcontraceptivestoapatientwhoisage17orolder.AmendstheIllinoisInsuranceCode.Requiresagrouporindividualpolicyofaccidentandhealthinsuranceormanagedcareplantoprovidecoverageforpatientcareservicesprovidedbyapharmacist.MakesconformingchangesintheStateEmployeesGroupInsuranceActof1971,theCountiesCode,theIllinoisMunicipalCode,andtheSchoolCode.AmendsthePharmacyPracticeAct.Providesthatthedefinitionof"practiceofpharmacy"includesthedispensingofhormonalcontraceptivespursuanttothestandingorderunderprovisionsoftheDepartmentofPublicHealthPowersandDutiesLawoftheCivilAdministrativeCodeofIllinois.AmendstheIllinoisPublicAidCode.Requiresthemedicalassistanceprogramtocoverpatientcareservicesprovidedbyapharmacistforhormonalcontraceptivesassessmentandconsultationforpatientswhoareage17orolder.EffectiveJanuary1,2020.
PrimarySponsorsMarkBatinick
BillSummary:LasteditedbyzAllieJoShipmanatMar21,2019,11:59AMThisbillprovidesthatapharmacistmaydispensea12-monthsupplyofhormonalcontraceptivestoapatientwhoisage17orolderpursuanttoastandingorder.Italsorequiresagrouporindividualpolicyofaccidentandhealthinsuranceormanagedcareplantoprovidecoverageforpatientcareservicesforhormonalcontraceptivesprovidedbyapharmacist.
Labels: BirthControl CompensationforServices
ScopeofPractice
TitleMedicaidprescriptiondrugprogram.
DescriptionRequirestheofficeofthesecretaryoffamilyandsocialservicestoprovideaprescriptiondrugbenefitforaMedicaidrecipientunder:(1)theriskbasedmanagedcareprogram;and(2)thehealthyIndianaplan.(Currentlawallowstheofficeorthemanagedcareorganizationtoprovidetheprescriptiondrugbenefit.)
PrimarySponsorsSteveDavisson
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,3:59PMThisbillwouldcarveMedicaidprescriptiondrugbenefitsoutofmanagedcareandrequirethemtobeadministeredbythestateunderfee-for-service.
Labels: MedicaidCarve-Out
State
ILBillNumber
HB3811LastAction
ReferredToRulesCommittee20190319Status
FailedsinediePosition
Support
State
INBillNumber
HB1249LastAction
FirstReadingReferredToCommitteeOnPublicHealth20190110
Status
FailedsinediePosition
Support
TitlePHARMACISTS:Providesrelativetopharmacyreimbursement
PrimarySponsorsBernardLeBas
TitleMEDICAID:ProvidesrelativetoMedicaidpharmacyservices.(8/1/19)
PrimarySponsorsT-FredMills
TitleMEDICAID:ProvidesrelativetotheMedicaidprescriptiondrugbenefitprogram.(8/1/19)(ENSEEFISCNOTEGFEXSeeNote)
PrimarySponsorsT-FredMills
Labels: MedicaidCarve-Out TransparencyandDisclosure
TitleAnActtopromotetransparencyandcostcontrolofpharmaceuticaldrugprices
DescriptionByMr.TosadoofSpringfield,apetition(accompaniedbybill,House,No.3551)ofJoséF.Tosadoandothersforlegislationtopromotetransparencyandcostcontrolofpharmaceuticaldrugprices.ElderAffairs.
State
LABillNumber
HB557LastAction
ReadByTitleUnderTheRulesReferredToTheCommitteeOnInsurance20190408
Status
FailedsinediePosition
None
State
LABillNumber
SB48LastAction
TitleOfSubstituteReadAndAdoptedBecomesSenateBillNo23920190502
Status
FailedsinediePosition
None
State
LABillNumber
SB239LastAction
SignedByTheGovernorBecomesActNo26320190611
Status
EnactedPosition
None
State
MABillNumber
H3551LastAction
HearingScheduledFor04112019From0100Pm0400PmInA120190404
Status
InHousePosition
None
TitleAnActmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutionsandcertainactivitiesofthecommonwealth,forinterest,sinkingfundandserialbondrequirementsandforcertainpermanentimprovements
PrimarySponsorsHouseCommitteeonWaysandMeans
TitleAnActmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutionsandcertainactivitiesofthecommonwealth,forinterest,sinkingfundandserialbondrequirementsandforcertainpermanentimprovements
TitleAnActmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutionsandcertainactivitiesofthecommonwealth,forinterest,sinkingfundandserialbondrequirementsandforcertainpermanentimprovements
DescriptionThecommitteeofconferenceonthedisagreeingvotesofthetwobrancheswithreferencetotheSenateamendmentoftheHouseBillmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutionsandcertainactivitiesoftheCommonwealth,forinterest,sinkingfundandserialbondrequirementsandforcertainpermanentimprovements(House,No.3801),reports,inpart,recommendingpassageoftheaccompanyingbill(House,No.4000).
PrimarySponsorsFY20GeneralAppropriationBill
Labels: TransparencyandDisclosure
State
MABillNumber
H3800LastAction
ReadThird20190422Status
InHousePosition
None
State
MABillNumber
H3801LastAction
PassedToBeEngrossedSeeRollCall62Yeas40Nays020190523
Status
PassedSenatePosition
None
State
MABillNumber
H4000LastAction
Item15956368PassedOverVeto125YeasTo31NaysSeeYeaAndNayInSupplementNo9220190918
Status
EnactedPosition
None
TitleAnActmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutions,andcertainactivitiesoftheCommonwealth,forinterest,sinkingfund,andserialbondrequirements,andforcertainpermanentimprovements
DescriptionAmessagefromHisExcellencytheGovernorsubmittingtheannualbudgetoftheCommonwealthforthefiscalyearbeginningJuly1,2019(House,No.1).
PrimarySponsorsCharlesD.Baker
TitleAnActmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutionsandcertainactivitiesofthecommonwealth,forinterest,sinkingfundandserialbondrequirementsandforcertainpermanentimprovements
DescriptionSenate,May23,2019–TextoftheSenateamendmenttotheHouseBillmakingappropriationsforthefiscalyear2020forthemaintenanceofthedepartments,boards,commissions,institutionsandcertainactivitiesofthecommonwealth,forinterest,sinkingfundandserialbondrequirementsandforcertainpermanentimprovements(House,No.3801)(beingthetextofSenate,No.3,printedasamended).
State
MABillNumber
HD1LastAction
ReportedInPartByH380020190410Status
InHousePosition
None
State
MABillNumber
S2235LastAction
SeeH380120190523Status
InSenatePosition
None
TitleMarylandMedicalAssistanceProgramandManagedCareOrganizationsThatUsePharmacyBenefitsManagers–AuditandProfessionalDispensingFees
DescriptionRequiringtheMarylandMedicalAssistanceProgramtoenterintoacontractwithanindependentauditorassoonaspracticabletoconductanauditofcertainpharmacybenefitsmanagersforthepurposeofdeterminingtheamountofMedicaidfundsusedtoreimbursemanagedcareorganization,pharmacybenefitsmanagers,andpharmaciesandthedollaramountoffundsreceivedbyeachrespectiveparty;requiringtheProgramtoprovidetheresultsoftheaudittotheGeneralAssemblyonorbeforeDecember1,2019;etc.
PrimarySponsorsErekBarron
BillSummary:LasteditedbyzAllieJoShipmanatMay20,2019,1:16PMThisbillrequirestheMarylandMedicalAssistanceProgramtodoanindependentauditofthePBMsinMedicaidmanagedcare.
TitleMarylandMedicalAssistanceProgramandManagedCareOrganizationsThatUsePharmacyBenefitsManagers-ReimbursementRequirements
DescriptionRequiringtheMarylandMedicalAssistanceProgramtoestablishreimbursementlevels,ratherthanmaximumreimbursementlevels,forcertaindrugproducts;requiringthatcertainminimumreimbursementlevelsbeatleastequaltotheNationalAverageDrugAcquisitionCostofthegenericproductplusacertainfee-for-serviceprofessionaldispensingfee;providingthatcertainprovisionsoftheActapplytomanagedcareorganizationsthatusepharmacybenefitsmanagerstomanageprescriptiondrugcoverage;etc.
PrimarySponsorsErekBarron
BillSummary:LasteditedbyzAllieJoShipmanatFeb21,2019,2:35PMThisbillwouldcreateaprescriptiondrugreimbursementfloorinMedicaidmanagedcareofNADACplustheMedicaidfee-for-servicedefineddispensingfee.
Labels: MedicaidReimbursementFloor
State
MDBillNumber
HB589LastAction
ApprovedByTheGovernorChapter53420190513
Status
EnactedPosition
None
State
MDBillNumber
HB1324LastAction
FirstReadingHouseRulesAndExecutiveNominations20190215
Status
FailedsinediePosition
Support
TitlePharmacists-AidsfortheCessationofTobaccoProductUse-PrescribingandDispensing
DescriptionAuthorizingapharmacistwhomeetstherequirementsofcertainregulationstoprescribeanddispenseaidsforthecessationoftheuseoftobaccoproducts;requiringtheStateBoardofPharmacy,bySeptember1,2020,toadoptcertainregulations;requiringtheMarylandMedicalAssistanceProgramandtheMarylandChildren'sHealthProgramtoprovidecoverageforcertainservicesrenderedbyalicensedpharmacistundertheActtothesameextentascertainservicesrenderedbyanyotherlicensedhealthcarepractitioner;etc.
PrimarySponsorsAntonioHayes
BillSummary:LasteditedbyzAllieJoShipmanatFeb6,2019,9:21PMThisbillmodifiesthedefinitionof"practiceofpharmacy"toincludeprescribinganddispensingmedicationsasanaidfortobaccousecessation.ItalsorequiresMarylandMedicalAssistanceProgramstoprovidecoverageforpharmacistservicesrenderedunderthissectiontothesameextentasservicesrenderedbyanyotherlicensedhealthcarepractitioner.
Labels: CompensationforServices ScopeofPractice
TobaccoCessation
TitleMarylandMedicalAssistanceProgramandManagedCareOrganizationsThatUsePharmacyBenefitsManagers-ReimbursementRequirements
DescriptionRequiringtheMarylandMedicalAssistanceProgramtoestablishreimbursementlevels,ratherthanmaximumreimbursementlevels,forcertaindrugproducts;requiringthatcertainminimumreimbursementlevelsbeatleastequaltotheNationalAverageDrugAcquisitionCostofthegenericproductplusacertainfee-for-serviceprofessionaldispensingfee;providingthatcertainprovisionsoftheActapplytomanagedcareorganizationsthatusepharmacybenefitsmanagerstomanageprescriptiondrugcoverage;etc.
PrimarySponsorsEdReilly
Labels: MedicaidReimbursementFloor NADAC+
TitleAppropriations;zerobudget;departmentofhealthandhumanservices;provideforfiscalyear2019-2020.Createsappropriationact.
PrimarySponsorsMaryWhiteford
State
MDBillNumber
SB497LastAction
UnfavorableReportByEducationHealthAndEnvironmentalAffairs20190311
Status
FailedsinediePosition
Support
State
MDBillNumber
SB1039LastAction
UnfavorableReportByFinanceWithdrawn20190320
Status
FailedsinediePosition
None
State
MIBillNumber
HB4235LastAction
ReassignedToCommitteeOnAppropriations20190829
Status
InSenatePosition
None
TitleOmnibushealthandhumanservicesfinancebill.
PrimarySponsorsTinaLiebling,DianeLoeffler,JenniferSchultz
TitleMedicalassistancereimbursementprovisionsfordirectinjectabledrugsmodified.
PrimarySponsorsKellyMorrison,DaveBaker
TitleMedicalassistance(MA)drugpaymentsgovernanceprovisionsmodifications
PrimarySponsorsMichelleBenson
TitleOmnibushealthandhumanservicesbudgetbill(governor's)
PrimarySponsorsJohnMarty
Labels: NADAC+
TitleOmnibushealthandhumanservicesappropriations
PrimarySponsorsMichelleBenson,JimAbeler
State
MNBillNumber
HF2414LastAction
SenateConfereesBensonAbelerUtkeJensenMarty20190501
Status
PassedSenatePosition
None
State
MNBillNumber
HF2791LastAction
ReferredByChairToHealthAndHumanServicesFinanceDivision20190401
Status
FailedsinediePosition
None
State
MNBillNumber
SF1778LastAction
ReferredToHealthAndHumanServicesFinanceAndPolicy20190227
Status
FailedsinediePosition
None
State
MNBillNumber
SF2302LastAction
CommReportToPassAsAmendedAndReReferToHealthAndHumanServicesFinanceAndPolicy20190403
Status
FailedsinediePosition
None
State
MNBillNumber
SF2452LastAction
Rule45AmendSubstGeneralOrdersHf241420190429
Status
FailedsinediePosition
None
TitleInjectabledrugsreimbursementprovisionsmodification
PrimarySponsorsMarkKoran,ChrisEaton
TitleMedicaid;pharmacybenefitsformanagedcarebeneficiariesshallbetraditionalfee-for-service.
DescriptionAnActToAmendSection43-13-117,MississippiCodeOf1972,ToProvideThatFromAndAfterJuly1,2019,PharmacyBenefitsForMedicaidBeneficiariesParticipatingInAnyManagedCareProgramOrCoordinatedCareProgramImplementedByTheDivisionOfMedicaidShallBeAdministeredByTheTraditionalFee-For-ServicePharmacyProgramOfTheDivision,WithRetailPoint-Of-SalePharmacyServicesForTheBeneficiaries;AndForRelatedPurposes.
PrimarySponsorsBeckyCurrie
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,4:12PMThisbillwouldcarveMedicaidprescriptiondrugbenefitsoutofmanagedcareandrequirethemtobeadministeredbythestateunderfee-for-service
Labels: MedicaidCarve-Out
Title2019Governor'sBudget.
PrimarySponsorsLindaJohnson,DonnyLambeth,JasonSaine,ChuckMcGrady
Title2019Governor'sBudget.
PrimarySponsorsHarryBrown,KathyHarrington,BrentJackson
State
MNBillNumber
SF2767LastAction
ReferredToHealthAndHumanServicesFinanceAndPolicy20190401
Status
FailedsinediePosition
None
State
MSBillNumber
HB335LastAction
DiedInCommittee20190205Status
FailedPosition
Support
State
NCBillNumber
HB588LastAction
RefToTheComOnFinanceIfFavorableAppropriationsIfFavorableRulesCalendarAndOperationsOfTheHouse20190404
Status
FailedsinediePosition
None
State
NCBillNumber
SB452LastAction
ReRefComOnAppropriationsBaseBudget20190403
Status
FailedsinediePosition
None
TitleRelatingToTheMedicalAssistancePharmacyManagementProgramAndPublicEmployeesRetirementSystemPrescriptionDrugCoverageBenefits;ToProvideForALegislativeManagementStudy;ToProvideForApplication;AndToProvideAnEffectiveDate.
DescriptionANACTtocreateandenactanewsectiontochapter50-24.1andanewsectiontochapter54‑52.1oftheNorthDakotaCenturyCode,relatingtothemedicalassistancepharmacymanagementprogramandpublicemployeesretirementsystemprescriptiondrugcoveragebenefits;toprovideforalegislativemanagementstudy;toprovideforapplication;andtoprovideaneffectivedate.
PrimarySponsorsMarvinNelson,RickHolman
BillSummary:LasteditedbyzAllieJoShipmanatMay20,2019,1:32PMThisbillrequiresallemployeeretirementsystemprescriptiondrugcoveragebenefitcontractstocontainlanguageallowingthestatetoconductperformanceauditsandallowingthestatefullaccesstodatarelatedtopharmacyreimbursements.
Titlerelativetoreportingofinternalpharmaceuticalcosts.
PrimarySponsorsEdButler
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,4:17PMThisbillrequireshealthcarrierstoannuallyreportspecificdatatotheinsurancecommissioner.Thisdataincludesspreadpricing,drugrebates,andPBMadministrativefees.
Labels: TransparencyandDisclosure
TitleRelativetocontractsfortheservicesofapharmacybenefitsmanager.
PrimarySponsorsEdButler
TitleRequiresallMedicaidmanagedcareorganizationtopermitallpharmaciesinStatetodispenseprescriptionsforallcoveredmedications.
PrimarySponsorsRajMukherji
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,4:35PMThisbillisan"anywillingpharmacy"billthatrequiresMedicaidmanagedcareorganizationstoallowallpharmaciesinthestatetofillforallcoveredmedicationsiftheyacceptthetermsandconditionsoftheMCO.TheSenatecompaniontothisbillisS961.
Labels: PatientProtections
State
NDBillNumber
HB1374LastAction
FiledWithSecretaryOfState050220190507Status
EnactedPosition
None
State
NHBillNumber
HB659LastAction
InexpedientToLegislateMaVv03192019Hj10P1420190319
Status
FailedPosition
Support
State
NHBillNumber
LSR2020-2705LastAction
NoneStatus Position
None
State
NJBillNumber
A2590LastAction
IntroducedReferredToAssemblyHealthAndSeniorServicesCommittee20180201
Status
FailedsinediePosition
Support
TitleRequiresprescriptiondrugservicescoveredunderMedicaidprogramtobeprovidedviafee-for-servicedeliverysystem.
PrimarySponsorsJoannDowney,EricHoughtaling,RajMukherji
TitleRequirespharmacybenefitsmanagerundercontractwithSHBPandSEHBPtoreportpricepaidtopharmacyandamountchargedtoSHBPandSEHBP.
PrimarySponsorsGarySchaer,RajMukherji
TitleRequirespharmacybenefitsmanagerprovidingserviceswithinMedicaidprogramtodisclosecertaininformationtoDHS.
PrimarySponsorsGarySchaer
TitleAppropriates$38,748,610,000inStatefundsand$16,748,645,972infederalfundsfortheStatebudgetforfiscalyear2019-2020.
PrimarySponsorsElianaPintorMarin,JohnBurzichelli
State
NJBillNumber
A5480LastAction
IntroducedReferredToAssemblyHumanServicesCommittee20190606
Status
InAssemblyPosition
None
State
NJBillNumber
A5496LastAction
IntroducedReferredToAssemblyStateAndLocalGovernmentCommittee20190606
Status
InAssemblyPosition
None
State
NJBillNumber
A5548LastAction
IntroducedReferredToAssemblyHumanServicesCommittee20190610
Status
InAssemblyPosition
None
State
NJBillNumber
A5600LastAction
SubstitutedByS202020190620Status
InAssemblyPosition
None
TitleRequiresMedicaidpreferreddrugliststoprovideforcoverageofbuprenorphinefortreatmentofchronicpain.
PrimarySponsorsCarolMurphy
TitleProhibitspharmacybenefitsmanagersfrommakingcertainretroactivereductionsinclaimspaymentstopharmacies;requirespharmacybenefitsmanagerstodisclosecertainproductinformationtopharmacies.
PrimarySponsorsLindaGreenstein,VinGopal
Labels: PatientProtections
RetroactiveReimbursementAdjustments
TitleRequiresallMedicaidmanagedcareorganizationtopermitallpharmaciesinStatetodispenseprescriptionsforallcoveredmedications.
PrimarySponsorsJoeVitale,VinGopal
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,4:35PMThisbillisan"anywillingpharmacy"billthatrequiresMedicaidmanagedcareorganizationstoallowallpharmaciesinthestatetofillforallcoveredmedicationsiftheyacceptthetermsandconditionsoftheMCO.TheAssemblycompaniontothisbillisA2590.
Labels: PatientProtections
TitleRequiresprescriptiondrugservicescoveredunderMedicaidprogramtobeprovidedviafee-for-servicedeliverysystem.
PrimarySponsorsVinGopal
State
NJBillNumber
A5704LastAction
IntroducedReferredToAssemblyHumanServicesCommittee20190627
Status
InAssemblyPosition
None
State
NJBillNumber
S728LastAction
SubstitutedByA37172R20190620Status
InSenatePosition
None
State
NJBillNumber
S961LastAction
IntroducedInTheSenateReferredToSenateHealthHumanServicesAndSeniorCitizensCommittee20180116
Status
FailedsinediePosition
Support
State
NJBillNumber
S3787LastAction
IntroducedInTheSenateReferredToSenateHealthHumanServicesAndSeniorCitizensCommittee20190520
Status
InSenatePosition
None
TitleRequirespharmacybenefitsmanagerprovidingserviceswithinMedicaidprogramtodisclosecertaininformationtoDHS.
PrimarySponsorsTroySingleton
TitleRequiresMedicaidpreferreddrugliststoprovideforcoverageofbuprenorphinefortreatmentofchronicpain.
PrimarySponsorsFredMadden
TitleMEDICAIDMANAGEDCAREPHARMACEUTICALBENEFITS
PrimarySponsorsJerryOrtizyPino
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,4:37PMThisbillwouldcarveMedicaidprescriptiondrugbenefitsoutofmanagedcareandrequirethemtobeadministeredbythestateunderfee-for-service.
Labels: MedicaidCarve-Out
TitleRevisesprovisionsrelatingtoprescriptiondrugs.(BDR38-114)
DescriptionANACTrelatingtoprescriptiondrugs;revisingprovisionsconcerningtheadministrationofcoverageofprescriptiondrugsundertheStatePlanforMedicaidandtheChildren'sHealthInsuranceProgram;revisingprovisionsgoverningrestrictionsimposedonthelistofpreferredprescriptiondrugstobeusedfortheMedicaidprogram;revisingthecriteriaforselectingprescriptiondrugsforinclusiononthatlist;authorizingthePharmacyandTherapeuticsCommitteetoclosecertainmeetingsundercertaincircumstances;andprovidingothermattersproperlyrelatingthereto.
PrimarySponsorsYvannaCancela,PatSpearman,JuliaRatti
State
NJBillNumber
S3929LastAction
IntroducedInTheSenateReferredToSenateHealthHumanServicesAndSeniorCitizensCommittee20190613
Status
InSenatePosition
None
State
NJBillNumber
S4007LastAction
IntroducedInTheSenateReferredToSenateHealthHumanServicesAndSeniorCitizensCommittee20190624
Status
InSenatePosition
None
State
NMBillNumber
SB184LastAction
ActionPostponedIndefinitely20190208Status
FailedPosition
Support
State
NVBillNumber
SB283LastAction
NoFurtherActionTaken20190604Status
FailedsinediePosition
None
TitleEnactsintolawmajorcomponentsoflegislationnecessarytoimplementthestatehealthandmentalhygienebudgetforthe2019-2020statefiscalyear
DescriptionEnactsintolawmajorcomponentsoflegislationnecessarytoimplementthestatehealthandmentalhygienebudgetforthe2019-2020statefiscalyear;extendsandenhancestheMedicaiddrugcapandreducesunnecessarypharmacybenefitmanagercoststotheMedicaidprogram(PartB);relatestoextensionoftheNationalDiabetesPreventionProgram(PartC);amendschapter59ofthelawsof2011inrelationtoextendingtheMedicaidglobalcap(PartD);extendscertainprovisionsofthepublichealthlawandthesocialserviceslawrelatingtohealthfacilities,certifiedhomehealthagencies,thegeneralpublichealthworkprogram,statefundmedicalexpenditures,hospitalassessments,residentialhealthcarefacilities,administrativecosts,welfarereform,Medicaid,andspecialneedsplans(PartE);extendscertainprovisionsrelatingtoexcesscoverage(PartF);relatestofiscalintermediaryservicesfortheconsumerdirectedpersonalassistanceprogram;relatestopaymentstohomecareaides;establishesaresidentialhealthcarefacilitiescasemixadjustmentworkgroup;andrepealscertainprovisionsofthesocialserviceslawrelatingthereto(PartG);relatestowaiversofcertainregulationsandtocertainratesandpaymentmethodologies;andrepealscertainprovisionsofthepublichealthlawrelatingthereto(PartH);relatestoguaranteedavailabilityofhealthinsuranceandcoverageforpre-existingconditions(SubpartA);relatestoactuarialvaluerequirementsandessentialhealthbenefits(SubpartB);relatestoprescriptiondrugcoverage(SubpartC);prohibitsdiscriminationbasedonsexandgenderidentity(SubpartD)(PartJ);relatestotheeffectivenessofcertainprovisionsrelatingtopaymentsfromthemedicalindemnityfund(PartK);includesiatrogenicinfertilityunderin-vitrofertilizationinsurancecoverage(PartL);requiresmedical,majormedical,orsimilarcomprehensivetypecoveragehealthinsurancepoliciestoincludecertainreproductivehealthcoverage;andclarifiesthedefinitionofvoluntarysterilizationproceduresandover-the-countercontraceptiveproducts(PartM);relatestothegeneralpublichealthworkprogram(PartO);relatestoleadlevels(PartP);relatestothehealthcarefacilitytransformationprogramstateIIIauthorizingadditionalawardsforstatewideIIapplications(PartQ);codifiesthecreationofNYstateofhealth,theofficialhealthplanmarketplace(PartT);relatestoprivatepayprotocolsforprogramsandservicesadministeredbytheofficefortheaging(PartU);implementscertaincompliancerequirementsonmanagedcareorganizationsandprovidersparticipatingintheMedicaidprogram(PartV);relatestotherecoveryofexemptincomebytheofficeofmentalhealthforcommunityres...(clickbilllinktoseemore).
PrimarySponsorsJoint2016GeneralBudgetConferenceCommittee
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,4:54PMThisbilllimitspaymentstoPBMstotheactualingredientcost,adispensingfee,andanadministrativefeeperclaiminmanagedcare.ItprohibitsPBMspreadpricinginmanagedcareandrequiresthePBMtoreportallsourcesofincometothehealthcareplan,includingrebates.ThisbillalsorequiresPBMstobelicensedbythesuperintendentofinsuranceandtosubmitannualreportstothesuperintendent,anditprovidesadditionaloversightauthoritytothesuperintendent.TheSenatecompaniontothisbillisS1507.(BudgetBill)
Labels: Registration/Licensure TransparencyandDisclosure
State
NYBillNumber
A2007LastAction
SubstituteS1507ActionSignedChap5720190412
Status
EnactedPosition
Support
TitleEnactsthemanufacturerdisclosureandtransparencyact
DescriptionEnactsthemanufacturerdisclosureandtransparencyactrequiringprescriptiondrugmanufacturerstonotifytheattorneygeneralofagreementsbetweenpharmaceuticalmanufacturersresultinginthedelayoftheintroductionofgenericmedications.
PrimarySponsorsMichaelDenDekker
TitleRelatestocontractednetworkpharmacyuse
DescriptionRelatestocontractednetworkpharmacyuse.
PrimarySponsorsHarryBronson
State
NYBillNumber
A7196LastAction
ReferredToConsumerAffairsAndProtection20190412
Status
FailedsinediePosition
None
State
NYBillNumber
A8117LastAction
ReferredToLabor20190603Status
FailedsinediePosition
None
TitleEnactsintolawmajorcomponentsoflegislationnecessarytoimplementthestatehealthandmentalhygienebudgetforthe2019-2020statefiscalyear
DescriptionEnactsintolawmajorcomponentsoflegislationnecessarytoimplementthestatehealthandmentalhygienebudgetforthe2019-2020statefiscalyear;extendsandenhancestheMedicaiddrugcapandreducesunnecessarypharmacybenefitmanagercoststotheMedicaidprogram(PartB);relatestoextensionoftheNationalDiabetesPreventionProgram(PartC);amendschapter59ofthelawsof2011inrelationtoextendingtheMedicaidglobalcap(PartD);extendscertainprovisionsofthepublichealthlawandthesocialserviceslawrelatingtohealthfacilities,certifiedhomehealthagencies,thegeneralpublichealthworkprogram,statefundmedicalexpenditures,hospitalassessments,residentialhealthcarefacilities,administrativecosts,welfarereform,Medicaid,andspecialneedsplans(PartE);extendscertainprovisionsrelatingtoexcesscoverage(PartF);relatestofiscalintermediaryservicesfortheconsumerdirectedpersonalassistanceprogram;relatestopaymentstohomecareaides;establishesaresidentialhealthcarefacilitiescasemixadjustmentworkgroup;andrepealscertainprovisionsofthesocialserviceslawrelatingthereto(PartG);relatestowaiversofcertainregulationsandtocertainratesandpaymentmethodologies;andrepealscertainprovisionsofthepublichealthlawrelatingthereto(PartH);relatestoguaranteedavailabilityofhealthinsuranceandcoverageforpre-existingconditions(SubpartA);relatestoactuarialvaluerequirementsandessentialhealthbenefits(SubpartB);relatestoprescriptiondrugcoverage(SubpartC);prohibitsdiscriminationbasedonsexandgenderidentity(SubpartD)(PartJ);relatestotheeffectivenessofcertainprovisionsrelatingtopaymentsfromthemedicalindemnityfund(PartK);includesiatrogenicinfertilityunderin-vitrofertilizationinsurancecoverage(PartL);requiresmedical,majormedical,orsimilarcomprehensivetypecoveragehealthinsurancepoliciestoincludecertainreproductivehealthcoverage;andclarifiesthedefinitionofvoluntarysterilizationproceduresandover-the-countercontraceptiveproducts(PartM);relatestothegeneralpublichealthworkprogram(PartO);relatestoleadlevels(PartP);relatestothehealthcarefacilitytransformationprogramstateIIIauthorizingadditionalawardsforstatewideIIapplications(PartQ);codifiesthecreationofNYstateofhealth,theofficialhealthplanmarketplace(PartT);relatestoprivatepayprotocolsforprogramsandservicesadministeredbytheofficefortheaging(PartU);implementscertaincompliancerequirementsonmanagedcareorganizationsandprovidersparticipatingintheMedicaidprogram(PartV);relatestotherecoveryofexemptincomebytheofficeofmentalhealthforcommunityres...(clickbilllinktoseemore).
PrimarySponsorsSenateCommitteeonBudgetandRevenues
BillSummary:LasteditedbyzAllieJoShipmanatMay20,2019,1:02PMThisbilllimitspaymentstoPBMstotheactualingredientcost,adispensingfee,andanadministrativefeeperclaiminmanagedcare.ItprohibitsPBMspreadpricinginmanagedcareandrequiresthePBMtoreportallsourcesofincometothehealthcareplan,includingrebates.ThisbillalsorequiresPBMstobelicensedbythesuperintendentofinsuranceandtosubmitannualreportstothesuperintendent,anditprovidesadditionaloversightauthoritytothesuperintendent.(BudgetBill)
Labels: Registration/Licensure TransparencyandDisclosure
State
NYBillNumber
S1507LastAction
SignedChap5720190412Status
EnactedPosition
Support
TitleEnactsthemanufacturerdisclosureandtransparencyact
DescriptionEnactsthemanufacturerdisclosureandtransparencyactrequiringprescriptiondrugmanufacturerstonotifytheattorneygeneralofagreementsbetweenpharmaceuticalmanufacturersresultinginthedelayoftheintroductionofgenericmedications.
PrimarySponsorsAlessandraBiaggi
TitleRegardstobaccocessationandprenatalinitiatives
DescriptionToamendsections5162.20,5167.01,and5167.12;toamend,forthepurposeofadoptinganewsectionnumberasindicatedinparentheses,section5164.10(5164.16);andtoenactnewsection5164.10andsections124.825,3701.614,3701.615,and5164.17oftheRevisedCodetoaddresstobaccocessationandprenatalinitiativesandtomakeanappropriation.
PrimarySponsorsGayleManning,StephanieHowse
State
NYBillNumber
S5169LastAction
ReferredToConsumerProtection20190412Status
FailedsinediePosition
None
State
OHBillNumber
HB11LastAction
ReferToCommitteeHealthHumanServicesAndMedicaid20190911
Status
InSenatePosition
None
TitleCreatesFY2020-2021operatingbudget
DescriptionToamendsections9.54,101.38,102.02,102.021,103.41,103.416,107.036,109.572,111.15,111.28,113.55,113.56,115.56,117.11,117.13,117.14,120.04,120.06,120.08,120.18,120.28,120.33,120.34,120.35,120.52,120.521,120.53,121.083,121.22,121.37,121.93,122.075,122.121,122.171,122.175,122.85,122.86,123.21,124.132,124.82,124.824,125.01,125.14,125.18,125.25,125.66,125.661,126.48,128.021,131.02,131.35,131.44,141.04,141.16,147.591,149.11,149.43,153.02,166.01,169.06,173.04,173.27,173.38,173.391,174.02,177.02,183.18,183.33,307.622,311.42,317.32,317.321,319.302,319.63,321.24,323.131,323.151,323.155,341.34,349.01,349.03,349.07,351.021,503.56,505.37,505.371,701.10,711.131,715.014,718.01,718.80,718.83,718.85,718.90,753.21,755.16,905.31,929.04,939.02,939.04,940.01,940.02,940.06,956.01,956.031,956.051,956.20,991.02,1321.73,1346.04,1347.08,1349.43,1501.31,1501.32,1501.33,1501.34,1501.35,1505.09,1509.28,1509.31,1509.36,1509.50,1521.01,1521.03,1521.04,1521.06,1521.062,1521.063,1521.16,1521.99,1522.10,1522.101,1522.11,1522.12,1522.13,1522.14,1522.15,1522.19,1522.20,1522.21,1533.10,1533.11,1533.111,1533.112,1533.32,1533.321,1561.011,1711.52,1711.53,1724.05,1726.11,1739.05,1751.77,1901.123,1901.26,1907.143,1907.24,2151.23,2151.233,2151.234,2151.235,2151.236,2151.353,2151.3516,2151.3532,2151.421,2151.424,2151.86,2151.87,2301.32,2303.201,2305.231,2305.41,2317.54,2925.01,2927.02,2927.022,2929.13,2929.15,2929.34,2941.51,2950.08,3105.011,3107.14,3109.061,3119.023,3119.05,3119.23,3119.27,3119.29,3119.30,3119.302,3119.31,3119.32,3125.25,3301.07,3301.0710,3301.0711,3301.0712,3301.0714,3301.52,3301.53,3301.68,3302.01,3302.03,3302.061,3302.18,3310.02,3310.03,3310.032,3310.035,3310.08,3310.16,3311.78,3311.79,3312.01,3313.411,3313.5315,3313.603,3313.608,3313.61,3313.611,3313.612,3313.618,3313.6110,3313.813,3313.843,3313.978,3314.016,3314.017,3314.02,3314.03,3314.06,3314.08,3314.18,3314.19,3314.21,3314.35,3314.351,3317.016,3317.02,3317.022,3317.023,3317.028,3317.03,3317.06,3317.13,3317.141,3317.16,3317.25,3317.40,3318.036,3318.05,3318.051,3318.06,3318.061,3318.062,3318.063,3318.36,3318.361,3319.26,3319.272,3319.283,3321.191,3326.031,3326.11,3326.13,3326.31,3326.32,3326.33,3326.34,3326.36,3326.37,3326.41,3327.10,3328.24,3333.26,3333.59,3333.61,3333.62,3333.65,3333.66,3345.48,3345.57,3353.07,3358.02,3358.06,3501.01,3501.05,3501.12,3501.22,3513.01,3513.12,3517.01,3517.10,3517.102,3517.1012,3517.11,3517.13,3517.153,3517.23,3517.99,3517.992,3701.044,3701.139,3701.144,3701.24,3701.262,3701.351,3701...(clickbilllinktoseemore).
PrimarySponsorsScottOelslager
State
OHBillNumber
HB166LastAction
Effective71819OperatingAppropriationsAndTaxLevyGenerallyEffectiveJuly182019OtherProvisionsGenerallyEffectiveOctober172019SomeProvisionsSubjectToSpecialEffectiveDates20190718
Status
EnactedPosition
None
TitleRelatingtobulkpurchasingofprescriptiondrugs;declaringanemergency.
DescriptionDirectsadministratorofOregonPrescriptionDrugProgramtocooperatewithStateofCaliforniainbulkpurchaseofprescriptiondrugs.RequiresadministratortosolicitcooperationfromCalifornianolaterthanDecember31,2019,andtoreporttointerimcommitteesofLegislativeAssemblybyDecember1ofeachyear,beginningin2020,onCalifornia'sresponsetosolicitation.Declaresemergency,effectiveonpassage.
TitleRelatingtothecostofprescriptiondrugs.
DescriptionRequirespharmaceuticalmanufacturerstoreporttoDepartmentofConsumerandBusinessServicestotalcostofpatientassistanceprogramsandinformationonfinancialassistanceprovidedtopharmacies,governmentagenciesandadvocacyorganizations.Excludesproprietaryinformationfromdisclosureondepartment'swebsite.Requiresstate-sponsoredprogramsthatusepharmacybenefitmanagerstousefee-onlypharmacybenefitmanagers.Requiresinsurerstopostspecifiedinformationregardingformulary,tiersandcoststoinsurer'swebsite.Requires60-dayadvancenoticetoenrolleesadverselyaffectedbychangeinformulary.Requiresinsurerandallowspharmacytonotifyinsuredthatifcashpricefordrugislessthaninsured'scost-sharefordrug,insuredmaypaycashpriceandexpensemustbecountedtowarddeductibleorout-of-pocketmaximum.Requireshospitalsandothermedicalproviderstodiscloseinpatientbillinginformationregardingmark-uponpriceofdrug.Alsorequiresbillingtodisclosepriceofdrugchargedtospecifiedstateagenciesandinsurers.RequiresspecifiedstateagenciestoreporttoLegislativeAssemblyonhigh-costdrugs.RequiresOregonHealthAuthoritytorefertoPharmacyandTherapeuticsCommitteeanydrugexceedingspecifiedcost.Requirespatientadvocacyorganizationwithbudgetexceeding$50,000thathasregisteredlobbyistinthisstatetoreporttoOregonGovernmentEthicsCommissionandOregonHealthAuthorityspecifiedinformationregardingfundingreceivedfromparticipantsinpharmaceuticalsupplychain.RequirespharmacybenefitmanagerstoreporttoDepartmentofConsumerandBusinessServicesandplansponsorsspecifiedinformationregardingrebates,reimbursements,feesandincentivespaidfordrugsbymanufacturers,insurersandpharmacies.Requiresdrugadvertisementtodisclosewholesalepriceofdrug.
State
ORBillNumber
HB2679LastAction
InCommitteeUponAdjournment20190630Status
FailedPosition
None
State
ORBillNumber
HB3093LastAction
InCommitteeUponAdjournment20190630Status
FailedPosition
None
TitleRelatingtothecostofprescriptiondrugs.
DescriptionRequirespharmaceuticalmanufacturerstoreporttoDepartmentofConsumerandBusinessServicestotalamountofmoneyspentonpatientassistanceprograms,informationonfinancialassistanceprovidedtopharmacies,governmentagenciesandadvocacyorganizationsandtotalamountoffinancialincentivespaidtoeachpharmacybenefitmanager.RequirespharmaceuticalmanufacturerstoreporttoDepartmentofConsumerandBusinessServicestotalcostof]amountofmoneyspentonpatientassistanceprograms,and]informationonfinancialassistanceprovidedtopharmacies,governmentagenciesandadvocacyorganizationsandtotalamountoffinancialincentivespaidtoeachpharmacybenefitmanager.Excludesproprietaryinformationfromdisclosureondepartment'swebsite.]Exemptsfrompublicdisclosureinformationreportedtodepartmentuntildepartmentpoststowebsiteallinformationreportedbymanufacturer.Requiresstate-sponsoredprogramsthatusepharmacybenefitmanagerstousefee-onlypharmacybenefitmanagers.Requiresinsurerstopostspecifiedinformationregardingformulary,tiersandcostsforsmallemployerandindividualhealthbenefitplanstoinsurer'swebsite.Requires60-dayadvancenoticetodepartmentandtoenrolleesadverselyaffectedbychangeinformulary.Requiresinsurerandallowspharmacytonotifyinsuredthatifcash]retailpricefordrugislessthaninsured'scost-share]out-of-pocketcostfordrugusingpharmacybenefit,insuredmaypaycash]retailpriceandexpensemustbecounted]ifrequestedbyenrollee,insurermustcountcosttowarddeductibleorout-of-pocketmaximum.RequiresStateBoardofPharmacytoprescribebyrulenoticeofenrollee'srightsfordistributiontopharmacycustomersandtotranslatenoticeintomultiplelanguages.Requireshospitalsandothermedicalproviderstodiscloseinpatientbillinginformationregardingmark-uponpriceofdrug.Alsorequiresbillingtodisclosepriceofdrugchargedtospecifiedstateagenciesandinsurers]reporttoOregonHealthAuthorityinformationregarding50mostprescribeddrugsand50mostexpensivedrugsprescribedbyprovider.RequiresspecifiedstateagenciestoreporttoLegislativeAssemblyonhigh-costdrugs.RequiresOregonHealthAuthoritytorefertoPharmacyandTherapeuticsCommitteeanydrugexceedingspecifiedcost.Requirespatientadvocacyorganizationwithbudget]annualgrossreceiptsexceeding$50,000thathasregisteredlobbyistinthisstatetoreporttoOregonGovernmentEthicsCommissionandOregonHealthAuthority]specifiedinformationregardingfundingreceivedfromparticipantsinpharmaceuticalsupplychain.RequirespharmacybenefitmanagerstoreporttoDepartmentofConsumerandBusinessServicesandplansponsorsspecifiedinfo...(clickbilllinktoseemore).
State
ORBillNumber
SB872LastAction
AtDeskUponAdjournment20190630Status
FailedPosition
None
TitleAnActamendingtheactofJune13,1967(P.L.31,No.21),knownastheHumanServicesCode,inpublicassistance,providingforfinancialdisclosuresforpharmacyservices.
PrimarySponsorsDoyleHeffley
TitleAnActamendingtheactofJune13,1967(P.L.31,No.21),knownastheHumanServicesCode,inpublicassistance,providingforuseofpharmacybenefitsmanagerbymedicalassistancemanagedcareorganization.
PrimarySponsorsSteveBarrar
TitleAnActamendingTitle24(Education)ofthePennsylvaniaConsolidatedStatutes,establishingthePublicSchoolEmployees'BenefitBoardandprovidingforitspowersandduties;requiringaschoolemployeehealthbenefitsevaluation;providingforahealthbenefitsprogramforpublicschoolemployees;andestablishingthePublicSchoolEmployees'BenefitTrustFund.
TitleAnActprovidingforconsumerprescriptiondrugpricingdisclosure,forpharmacyfreedomtocommunicateandforenforcementbytheInsuranceDepartment.
TitleAnActamendingtheactofJune13,1967(P.L.31,No.21),knownastheHumanServicesCode,inpublicassistance,providingforuseofpharmacybenefitsmanagerbymedicalassistancemanagedcareorganization.
State
PABillNumber
HB941LastAction
LaidOnTheTable20190917Status
InHousePosition
None
State
PABillNumber
HB945LastAction
ReferredToHealth20190618Status
InHousePosition
None
State
PABillNumber
SB604LastAction
ReferredToEducation20190430Status
InSenatePosition
None
State
PABillNumber
SB639LastAction
ReferredToBankingAndInsurance20190513Status
InSenatePosition
None
State
PABillNumber
SB789LastAction
ReferredToHealthAndHumanServices20190709
Status
InSenatePosition
None
TitleAnActamendingtheactofJune13,1967(P.L.31,No.21),knownastheHumanServicesCode,inpublicassistance,providingforpharmacybenefitsmanagerauditandobligations.
Labels: TransparencyandDisclosure
TitlePharmacyAccessAct
DescriptionABillToAmendTheCodeOfLawsOfSouthCarolina,1976,ToEnactThe"PharmacyAccessAct"ByAddingChapter138ToTitle44SoAsToProvideThatQualifiedLicensedPharmacistsMayPrescribeAndAdministerInjectableHormonalContraceptivesAndPrescribeAndDispenseSelf-AdministeredHormonalContraceptivesUnderAStandingPrescriptionDrugOrder,ToProvideForWrittenJointProtocolProvisions,AndToDefineNecessaryTerms.
PrimarySponsorsToddRutherford
BillSummary:LasteditedbyzAllieJoShipmanatFeb7,2019,8:49PMThisbillallowspharmaciststodispenseaself-administeredhormonalcontraceptiveoradministeraninjectablehormonalcontraceptivepursuanttoastandingordertoapatientovertheageof18orunder18whohasevidenceofapreviousprescriptionfromapractitionerforaself-administeredorinjectablehormonalcontraceptive.ThisbillalsostatesthatpharmacistservicesareabenefitunderthestateMedicaidprogramandrequiresthedepartmenttoestablishafeeschedulefortheaforementionedpharmacistservicesatareimbursementrateof70%ofthefeescheduleforphysicianservices.TheSenatecompanionbillisS448.
Labels: BirthControl CompensationforServices
ScopeofPractice
TitlePharmacy,Pharmacists-Asintroduced,removestheuseofstate-fundedpharmacybenefitsmanagers;removescertainexemptionunderpublicrecordslaw.-AmendsTCATitle4;Title8;Title10;Title56;Title63;Title68andTitle71.
PrimarySponsorsBryanTerry
BillSummary:LasteditedbyzAllieJoShipmanatFeb7,2019,8:25PMThisbillwouldeffectivelycarveMedicaidprescriptiondrugbenefitsoutofmanagedcareandrequirethemtobeadministeredbythestateunderfee-for-service.TheSenatecompanionbillisS987.
Labels: MedicaidCarve-Out
State
PABillNumber
SB829LastAction
ReferredToHealthAndHumanServices20190815
Status
InSenatePosition
None
State
SCBillNumber
H3844LastAction
MemberSRequestNameAddedAsSponsorRose20190311
Status
FailedsinediePosition
Support
State
TNBillNumber
HB1179LastAction
TakenOffNoticeForCalInSCLifeHealthInsuranceSubcommitteeOfInsuranceCommittee20190403
Status
FailedsinediePosition
Support
TitlePharmacy,Pharmacists-Asenacted,makesvariouschangestolawconcerningpharmacybenefitsmanagers.-AmendsTCATitle56,Chapter7,Part31.
PrimarySponsorsShaneReeves
BillSummary:LasteditedbyzAllieJoShipmanatFeb6,2019,3:21PMThisbillamendsprovisionsrelatedtofairpharmacyauditstoclarifythatclericalerrorsarenotprimafacieevidenceoffraudandtoprohibitrecoupmentforthecostofthedrugordispensedproductexceptincertaincircumstances.Thisbillalsoprohibitsclaimsadjudicationfeesunlessapparentandassessedatthetimeofclaimsprocessing;prohibitscontracttermsrequiringapharmacisttodispenseadrugtoapatient;prohibitsaPBMfromnotifyingpatientsoftheremovalofapharmacyfromanetworkpriortonotifyingthepharmacy;andmandatesPBMsnotifynetworkpharmaciesofmaterialchangestocontractprovisionsatleast30dayspriortotheeffectivedate.ThisbillrequiresthestatecomptrollertoperformanannualauditofPBMsprovidingservicesfundedbythestate.ItalsorequirescontracttermsbetweenPBMsandpharmaciestobemutuallyagreedupon;prohibitsfalseormisleadingadvertisementsorrepresentationbyPBMs;prohibitsPBMsfromfailingtomakepaymentstopharmaciesremovedfromanetworkifservicesbythepharmacywereproperlyrendered;prohibitsPBMsfromreimbursingnon-affiliatedpharmacieslessthanitreimbursesitselforaffiliatedpharmacies;andprohibitsPBMsfromdesignatingadrugasaspecialtydrugbasedsolelyoncost.
Labels: FairPharmacyAudits PatientProtections
TransparencyandDisclosure
TitlePharmacy,Pharmacists-Asintroduced,removestheuseofstate-fundedpharmacybenefitsmanagers;removescertainexemptionunderpublicrecordslaw.-AmendsTCATitle4;Title8;Title10;Title56;Title63;Title68andTitle71.
PrimarySponsorsShaneReeves
BillSummary:LasteditedbyzAllieJoShipmanatFeb7,2019,8:25PMThisbillwouldeffectivelycarveMedicaidprescriptiondrugbenefitsoutofmanagedcareandrequirethemtobeadministeredbythestateunderfee-for-service.TheHousecompanionbillisHB1179.
Labels: MedicaidCarve-Out
TitleRelatingtothereimbursementofprescriptiondrugsunderMedicaidandthechildhealthplanprogram.
PrimarySponsorsJ.D.Sheffield,GregBonnen,FourPrice,ColeHefner,RichardRaymond,LoisKolkhorst
Labels: MedicaidCarve-Out PatientProtections
State
TNBillNumber
SB650LastAction
CompBecamePubCh47020190529Status
EnactedPosition
Support
State
TNBillNumber
SB987LastAction
AssignedToGeneralSubcommitteeOfSenateCommerceAndLaborCommittee20190402
Status
FailedsinediePosition
Support
State
TXBillNumber
HB3388LastAction
ConfCommReportDistributed20190525Status
PassedSenatePosition
None
TitleRelatingtodeliveryofoutpatientprescriptiondrugbenefitsundercertainpublicbenefitprograms,includingMedicaidandthechildhealthplanprogram.
PrimarySponsorsRichardRaymond
Labels: MedicaidCarve-Out PatientProtections
TitleRelatingtoreimbursementundercertainhealthbenefitplansforcertainservicesandproceduresperformedbypharmacists.
PrimarySponsorsEddieLucio,CharlesSchwertner
BillSummary:LasteditedbyzAllieJoShipmanatMar8,2019,1:03AMThisbillprohibitsaninsurerfromdenyingreimbursementtoapharmacistfortheprovisionofaserviceorprocedurewithinthepharmacist'sscopeofpracticeiftheserviceiscoveredbytheinsurerwhenprovidedbyaphysician,advancedpracticenurse,orphysician'sassistant.
Labels: CompensationforServices
TitleRelatingtotheadministrationandoperationofMedicaid,includingMedicaidmanagedcare.
PrimarySponsorsLoisKolkhorst,JamesFrank,StephanieKlick
TitleRelatingtodeliveryofoutpatientprescriptiondrugbenefitsundercertainpublicbenefitprograms,includingMedicaidandthechildhealthplanprogram.
PrimarySponsorsLoisKolkhorst
Labels: MedicaidCarve-Out
State
TXBillNumber
HB3401LastAction
WithdrawnFromSchedule20190403Status
FailedsinediePosition
None
State
TXBillNumber
HB3441LastAction
EffectiveOn911920190531Status
EnactedPosition
Support
State
TXBillNumber
SB1105LastAction
HouseAppointsConfereesReported20190523
Status
PassedHousePosition
None
State
TXBillNumber
SB2262LastAction
ReferredToFinance20190321Status
FailedsinediePosition
None
TitleRelatingtotheprovisionofpharmacybenefitsthroughMedicaidmanagedcare.
PrimarySponsorsLoisKolkhorst
Labels: MedicaidCarve-Out
TitleBudgetBill.
DescriptionBudgetBill.AmendsChapter2,2018SpecialSessionIActsofAssembly.
PrimarySponsorsChrisJones
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,5:10PMThisbillrequiresMedicaidmanagedcareorganizationstoprovidequarterlyreportstothestaterelatedtopharmacyclaims.Itrequiresclaims-leveldataondrugcostreimbursement,dispensingfees,copayments,andtheamountchargedtotheplansponsor(state).Italsorequiresanitemizationofalladministrativefees,rebates,andprocessingchargesassociatedwitheachclaim.ThisbillalsorequiresthirdpartyadministratorsforstateemployeehealthplanstoprovidesimilarinformationtostateemployeesthroughanexplanationofbenefitsandtoprovideaggregatedatatothestaterelatedtothedifferencesinamountspaidtopharmaciesbythePBM,chargedtotheTPAbythePBM,andchargedtothestatebytheTPA.(BudgetBill)
Labels: TransparencyandDisclosure
TitleHealthinsuranceratereviews;pharmacybenefitpricespread.
DescriptionHealthinsuranceratereviews;minimumanticipatedlossratios;pharmacybenefitpricespread.RequirestheStateCorporationCommission(Commission)totreatthepricespreadonanycontractbetweentheissuerofahealthbenefitplananditspharmacybenefitsmanagerasanadministrativecostoftheissuer.Themeasurerequirestheissuer'sadministrativecoststobeexcludedfromtheamountofbenefitsprovidedunderahealthbenefitplanwhentheCommissiondeterminesthehealthbenefitplan'santicipatedlossratio.ThemeasurecodifiesportionsoftheCommission'sregulationspromulgatedtoimplementtherequirementthatitreviewandapprovethepremiumratesforhealthbenefitplans,includingtherequirementthatthebenefitsprovidedbyahealthbenefitplanarereasonableinrelationtothepremiumscharged.
PrimarySponsorsKeithHodges
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,5:19PMThisbillrequireshealthinsuranceissuerstoapplyanypricespreadbyaPBMasanadministrativecostandnotahealthbenefitforthepurposesofcalculatingtheanticipatedlossratio.Itallowsonlytheamountpaidtothepharmacytobecountedasahealthbenefit.
Labels: MLR TransparencyandDisclosure
State
TXBillNumber
SB2267LastAction
ReferredToFinance20190321Status
FailedsinediePosition
None
State
VABillNumber
HB1700LastAction
GovernorActsOfAssemblyChapterTextChap085420190502
Status
EnactedPosition
Support
State
VABillNumber
HB2516LastAction
HouseLeftInCommerceAndLabor20190205Status
FailedPosition
Support
TitleMaking2017-2019bienniumsecondsupplementaloperatingappropriations.
PrimarySponsorsTimmOrmsby
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,5:23PMThisbillrequiresmanagedcareorganizationstoreportprescriptiondrug-specificinformationtothestate,includingtheactualamountspaidtopharmaciesfordispenseddrugs,thecostinvoicedtothehealthplan(state),andindividualrebatescollectedforprescriptiondrugsdispensed.Italsorequiresmanagedcareorganizationstouseastate-establishedpreferreddruglist(PDL).TheSenatecompanionbillisS5154.(BudgetBill)
Labels: TransparencyandDisclosure
TitleMaking2017-2019bienniumsecondsupplementaloperatingappropriations.
PrimarySponsorsChristineRolfes
BillSummary:LasteditedbyzAllieJoShipmanatFeb1,2019,5:24PMThisbillrequiresmanagedcareorganizationstoreportprescriptiondrug-specificinformationtothestate,includingtheactualamountspaidtopharmaciesfordispenseddrugs,thecostinvoicedtothehealthplan(state),andindividualrebatescollectedforprescriptiondrugsdispensed.Italsorequiresmanagedcareorganizationstouseastate-establishedpreferreddruglist(PDL).TheHousecompanionbillisHB1108.(BudgetBill)
Labels: TransparencyandDisclosure
State
WABillNumber
HB1108LastAction
PublicHearingInTheHouseCommitteeOnAppropriationsAt330Pm20190114
Status
FailedsinediePosition
Support
State
WABillNumber
SB5154LastAction
PublicHearingInTheSenateCommitteeOnWaysMeansAt330Pm20190115
Status
FailedsinediePosition
Support
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