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A bill to be entitled |
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An act relating to pharmacy benefit managers; creating s. |
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465.189, F.S.; establishing standards and criteria for |
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regulation and licensing of pharmacy benefit managers; |
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providing a popular name; providing purpose, intent, and |
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applicability; providing definitions; requiring a biennial |
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certificate of authority and an annual license; providing |
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rulemaking authority to the Board of Pharmacy and the |
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Office of Insurance Regulation; requiring an annual |
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statement; providing for financial examinations; providing |
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for assessments and fees; providing for pharmacy benefit |
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manager contracts; providing for enforcement; providing |
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for medication reimbursement costs; specifying prohibited |
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practices; preserving existing contracts and providing |
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prospective application for new contracts; providing for |
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control over conflicting provisions of law; providing an |
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effective date. |
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Be It Enacted by the Legislature of the State of Florida: |
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Section 1. Section 465.189, Florida Statutes, is created |
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to read: |
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465.189 Pharmacy benefit managers.--
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(1) POPULAR NAME.--This section shall be known by the |
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popular name the "Florida Pharmacy Benefit Management Regulation |
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Act."
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(2) PURPOSE AND INTENT; APPLICABILITY.--
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(a)1. This section establishes standards and criteria for |
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the regulation and licensing of pharmacy benefit managers.
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2. The purpose of this section is to:
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a. Promote, preserve, and protect the public health, |
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safety, and welfare through effective regulation and licensing |
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of pharmacy benefit managers.
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b. Provide for certain powers and duties for certain state |
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agencies and officers.
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c. Prescribe penalties for violations of this section.
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(b) A pharmacy benefit manager is subject to this section |
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if the pharmacy benefit manager provides claims-processing |
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services, other prescription drug or device services, or both, |
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to patients who are residents of this state.
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(c) A pharmacy benefit manager may not do business or |
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provide services in this state unless the pharmacy benefit |
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manager is in full compliance with this section.
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(3) DEFINITIONS.--For purposes of this section:
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(a) "Board" means the Board of Pharmacy.
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(b) "Cease and desist order" means an order of the board |
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or office prohibiting a pharmacy benefit manager or other person |
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or entity from continuing a particular course of conduct that |
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violates this section or rules adopted under this section.
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(c) "Claims-processing services" means the administrative |
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services performed in connection with the processing and |
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adjudication of claims relating to pharmacist's services, |
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including, but not limited to, making payments to pharmacists |
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and pharmacies.
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(d) "Maintenance drug" means a drug prescribed by a |
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practitioner who is licensed to prescribe drugs and used to |
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treat a medical condition for a period greater than 30 days.
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(e) "Multi-source drug" means a drug that is stocked and |
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available from three or more suppliers.
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(f) "Office" means the Office of Insurance Regulation of |
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the Financial Services Commission.
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(g) "Other prescription drug or device services" means |
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services other than claims-processing services, provided |
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directly or indirectly by a pharmacy benefit manager, whether in |
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connection with or separate from claims-processing services, |
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including, but not limited to:
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1. Negotiating rebates, discounts, or other financial |
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incentives and arrangements with drug companies.
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2. Disbursing or distributing rebates.
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3. Managing or participating in incentive programs or |
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arrangements for pharmacist's services.
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4. Negotiating or entering into contractual arrangements |
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with pharmacists or pharmacies, or both.
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5. Developing formularies.
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6. Designing prescription benefit programs.
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7. Advertising or promoting claims-processing services or |
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other prescription drug or device services.
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(h) "Pharmacist" means an individual licensed as a |
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pharmacist under this chapter.
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(i) "Pharmacist's services" means the practice of the |
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profession of pharmacy as defined in s. 465.003.
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(j) "Pharmacy" means pharmacy as defined in s. 465.003.
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(k)1. "Pharmacy benefit manager" means a person, business, |
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or other entity, and any wholly or partially owned or controlled |
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subsidiary of a pharmacy benefit manager, that provides claims- |
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processing services or other prescription drug or device |
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services, or both, to third parties.
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2. "Pharmacy benefit manager" does not include licensed |
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health care facilities, pharmacies, licensed health care |
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professionals, insurance companies, unions, or health |
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maintenance organizations.
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(l) "Single-source drug" means a drug that is not a multi- |
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source drug.
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(m)1. "Third parties" means any person, business, or other |
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entity other than a pharmacy benefit manager.
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2. "Third parties" does not include:
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a. A person, business, or other entity that owns or holds |
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a controlling interest in the pharmacy benefit manager; or
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b. A person, business, or other entity in which the |
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pharmacy benefit manager owns or holds a controlling interest.
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(n) "Usual and customary price" means the price that a |
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pharmacist or pharmacy would have charged cash-paying patients, |
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excluding patients for whom reimbursement rates are set by |
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contract, for the same services on the same date.
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(4) CERTIFICATE OF AUTHORITY.--
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(a)1. No person or organization shall establish or operate |
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as a pharmacy benefit manager in this state without obtaining a |
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certificate of authority from the board in accordance with this |
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section and all applicable federal and state laws.
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2. A pharmacy benefit manager doing business in this state |
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shall obtain a certificate of authority from the board within |
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120 days after the effective date of this section and every 2 |
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years thereafter. The certificate of authority shall expire on |
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December 31 in the year following the year the certificate of |
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authority was first issued and then may be renewed for |
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successive 2-year periods.
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(b)1. Any organization or person may apply to the board to |
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obtain a certificate of authority to establish and operate a |
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pharmacy benefit manager under this section.
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2. A nonrefundable application fee of $300, payable to the |
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board, shall accompany each application for a certificate of |
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authority and each application for renewal of a certificate of |
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authority.
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(c) The board shall not issue a certificate of authority |
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to any pharmacy benefit manager until the board is satisfied |
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that the pharmacy benefit manager:
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1. Holds a current license issued by the office to do |
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business in this state as a pharmacy benefit manager.
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2. Is ready and able to arrange for pharmacist's services |
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in this state.
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3. Meets the requirements set forth in this section and in |
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rules adopted under this section.
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4. Is in compliance with all applicable state and federal |
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laws and regulations.
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(d) The board may suspend or revoke any certificate of |
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authority issued to a pharmacy benefit manager under this |
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section, deny an application for a certificate of authority to |
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an applicant, or deny an application for renewal of a |
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certificate of authority if it finds that:
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1. The pharmacy benefit manager is operating materially in |
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contravention of:
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a. Its application or other information submitted as a |
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part of its application for a certificate of authority or |
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renewal of its certificate of authority; or
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b. Any condition imposed by the board with regard to the |
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issuance or renewal of its certificate of authority;
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2. The pharmacy benefit manager does not arrange for |
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pharmacist's services;
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3. The pharmacy benefit manager has failed to continuously |
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meet the requirements for issuance of a certificate of authority |
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as set forth in this section or any rules adopted under this |
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section;
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4. The pharmacy benefit manager has otherwise failed to |
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substantially comply with this section or any rules adopted |
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under this section;
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5. The continued operation of the pharmacy benefit manager |
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may be hazardous to patients; or
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6. The pharmacy benefit manager has failed to |
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substantially comply with any applicable state or federal law or |
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regulation.
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(e)1. When the certificate of authority of a pharmacy |
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benefit manager is revoked, the manager shall:
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a. Proceed, immediately following the effective date of |
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the order of revocation, to wind up its affairs.
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b. Conduct no further business except as may be essential |
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to the orderly conclusion of its affairs.
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2. The board may permit any further operation of the |
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pharmacy benefit manager as the board may find to be in the best |
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interest of patients to the end that patients will have the |
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greatest practical opportunity to obtain pharmacist's services.
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(5) LICENSE TO DO BUSINESS.--
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(a)1. No person or organization shall establish or operate |
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as a pharmacy benefit manager in this state without first |
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obtaining a license from the office in accordance with this |
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section and all applicable federal and state laws.
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2. A pharmacy benefit manager doing business in this state |
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shall obtain a license from the office within 60 days after the |
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effective date of this section and each year thereafter.
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(b)1. An application for a license to operate in this |
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state as a pharmacy benefit manager shall be in a form |
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prescribed by the office and shall be verified by an officer or |
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authorized representative of the pharmacy benefit manager.
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2. The application shall include at least the following:
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a. All organizational documents, including, but not |
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limited to, articles of incorporation, bylaws, and other similar |
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documents and any amendments.
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b. The names, addresses, and titles of individuals |
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responsible for the business and services provided, including |
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all claims-processing services and other prescription drug or |
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device services.
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c. The names, addresses, titles, and qualifications of the |
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members and officers of the board of directors, board of |
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trustees, or other governing body or committee, or the partners |
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or owners in case of a partnership, other entity, or |
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association.
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d. A detailed description of the claims-processing |
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services and other prescription drug or device services provided |
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or to be provided.
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e. The name and address of the agent for service of |
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process in this state.
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f. Financial statements for the current and the preceding |
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year showing the assets, liabilities, direct or indirect income, |
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and any other sources of financial support sufficient, as deemed |
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by the office, to show financial stability and viability to meet |
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its full obligations to pharmacies and pharmacists.
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g. A bond in an amount determined by the office by rule to |
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ensure that funds received by the pharmacy benefit manager for |
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pharmacist's services are, in fact, paid to appropriate |
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pharmacies and pharmacists.
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h. All incentive arrangements or programs such as rebates, |
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discounts, disbursements, or any other similar financial program |
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or arrangement relating to income or consideration received or |
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negotiated, directly or indirectly, with any pharmaceutical |
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company that relates to other prescription drug or device |
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services, including, but not limited to:
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(I) Information on the formula or other method for |
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calculation and amount of the incentive arrangements, rebates, |
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or other disbursements.
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(II) The identity of the associated drug or device.
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(III) The dates and amounts of the disbursements.
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i. Other information as the office may require.
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(c) The office shall not issue an annual pharmacy benefit |
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manager license to do business in this state to any pharmacy |
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benefit manager until the office is satisfied that the pharmacy |
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benefit manager has:
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1. Paid all fees, taxes, and charges required by law.
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2. Filed a financial statement or statements and any |
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reports, certificates, or other documents the office considers |
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necessary to secure a full and accurate knowledge of the |
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pharmacy benefit manager's affairs and financial condition.
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3.a. Established its solvency.
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b. Satisfied the office that the pharmacy benefit |
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manager's financial condition, method of operation, and manner |
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of doing business make it possible for the pharmacy benefit |
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manager to meet its obligations to pharmacies and pharmacists.
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4. Otherwise complied with all the requirements of law.
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5. Obtained a bond in an amount determined by the office |
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to ensure that funds received by the pharmacy benefit manager |
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for pharmacist's services are, in fact, paid to appropriate |
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pharmacies and pharmacists.
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(d)1. The annual pharmacy benefit manager license shall be |
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in addition to the certificate of authority issued by the board.
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2. A nonrefundable license application fee of $500 shall |
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accompany each application for a license to transact business in |
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this state.
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3. The fee shall be collected by the office and paid |
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directly into the Insurance Commissioner's Regulatory Trust Fund |
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to provide expenses for the regulation, supervision, and |
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examination of all entities subject to regulation under this |
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section.
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(e) The pharmacy benefit manager license shall be signed |
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by the office or an authorized agent of the office and shall |
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expire 1 year after the date the license becomes effective.
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(f)1. A pharmacy benefit manager transacting business in |
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this state shall obtain an annual renewal of its license from |
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the office.
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2. The office may refuse to renew the license of any |
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pharmacy benefit manager or may renew the license, subject to |
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any restrictions considered appropriate by the office, if the |
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office finds that the pharmacy benefit manager has not satisfied |
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all the conditions stated in this section.
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3.a. Before denying renewal of a license, the office shall |
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provide the pharmacy benefit manager:
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(I) At least 10 days' advance notice of the denial.
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(II) An opportunity to appear at a formal or informal |
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hearing.
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b. The office and the pharmacy benefit manager may jointly |
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waive the required notice.
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(6) RULES.--
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(a) The board may adopt rules not inconsistent with this |
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section regulating pharmacy benefit managers with regard to |
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professional, public health, and public safety issues.
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(b) The office may adopt rules not inconsistent with this |
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section regulating pharmacy benefit managers with regard to |
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business and financial issues.
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(c) Rules adopted under this section may set penalties, |
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including, but not limited to, monetary fines, for violations of |
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this section and rules adopted under this section.
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(7) ANNUAL STATEMENT.--
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(a)1. A pharmacy benefit manager doing business in this |
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state shall file a statement with the office annually by March |
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1.
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2. The statement shall be verified by at least two |
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principal officers of the pharmacy benefit manager and shall |
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cover the preceding calendar year.
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(b) The statement shall be on forms prescribed by the |
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office and shall include:
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1. A financial statement of the organization, including |
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its balance sheet and income statement for the preceding year.
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2. The number and dollar value of claims for pharmacist's |
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services processed by the pharmacy benefit manager during the |
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preceding year with respect to patients who are residents of |
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this state.
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3. Any other information relating to the operations of the |
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pharmacy benefit manager required by the office.
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(c) If a pharmacy benefit manager is audited annually by |
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an independent certified public accountant, a copy of each |
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certified audit report shall be promptly filed with the office.
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(d)1. The office may extend the time prescribed for any |
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pharmacy benefit manager for filing annual statements or other |
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reports or exhibits for good cause shown.
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2. The office may not extend the time for filing annual |
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statements beyond 60 days after the time prescribed in this |
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section.
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3. Until the annual statement is filed, the office may |
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revoke or suspend the license of a pharmacy benefit manager that |
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fails to file its annual statement within the time prescribed by |
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this section.
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(8) FINANCIAL EXAMINATION.--
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(a)1. The office shall regularly conduct financial |
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examinations of all pharmacy benefit managers doing business in |
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this state pursuant to a schedule and in a manner established by |
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rule.
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2. The examination shall verify:
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a. The financial ability of the pharmacy benefit manager |
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to meet its full obligations to pharmacies and pharmacists.
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b. Information submitted to the office as a part of an |
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application for a license or renewal of a license.
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c. Compliance with this section.
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(b) In lieu of, or in addition to, making the financial |
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examination of a pharmacy benefit manager, the office may accept |
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the report of a financial examination of the pharmacy benefit |
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manager under the laws of another state certified by its |
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insurance office, similar regulatory agency, or state health |
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agency to the extent that the report of financial examination |
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covers the minimum requirements specified in paragraph (a).
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(c)1. The office shall coordinate financial examinations |
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of pharmacy benefit managers to ensure an appropriate level of |
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regulatory oversight and to avoid any undue duplication of |
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effort or regulation.
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2. The pharmacy benefit manager being examined shall pay |
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the cost of the examination.
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3. The cost of the examination shall be deposited into the |
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Insurance Commissioner's Regulatory Trust Fund to provide all |
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expenses for the regulation, supervision, and examination of all |
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entities subject to regulation under this section.
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(9) ASSESSMENT.--
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(a) Except as provided in subparagraph (8)(c)3., the |
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expense of administering this section incurred by the office |
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shall be assessed annually by the office against all pharmacy |
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benefit managers operating in this state.
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(b) The office shall assess each pharmacy benefit manager |
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annually for its share of the office's estimated expenses with |
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regard to this section in proportion to the business done in |
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this state, as determined by the office in the office's |
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reasonable discretion.
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(c)1. The office shall give each pharmacy benefit manager |
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notice of the assessment, which shall be paid to the office |
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before March 2 of each year.
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2. A pharmacy benefit manager that fails to pay the |
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assessment before March 2 of each year shall be subject to a |
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penalty imposed by the office.
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3. The penalty shall be 10 percent of the assessment plus |
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interest for the period between the due date and the date of |
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full payment.
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4. If a payment is made in an amount later found to be in |
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error, the office shall:
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a. If an additional amount is due:
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(I) Notify the pharmacy benefit manager of the additional |
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360
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amount due.
|
|
361
|
(II) Order the pharmacy benefit manager to pay the |
|
362
|
additional amount within 14 days after the date of the notice.
|
|
363
|
b. If an overpayment is made, order a refund to the |
|
364
|
pharmacy benefit manager.
|
|
365
|
(d)1. If an assessment made under this section is not paid |
|
366
|
to the office by the prescribed date, the amount of the |
|
367
|
assessment, plus any penalty, may be recovered from the |
|
368
|
defaulting pharmacy benefit manager on motion of the office made |
|
369
|
in the name and for the use of the State of Florida in the |
|
370
|
Circuit Court of Leon County, after 10 days' notice to the |
|
371
|
pharmacy benefit manager.
|
|
372
|
2. The license of any defaulting pharmacy benefit manager |
|
373
|
to transact business in this state may be revoked or suspended |
|
374
|
by the office until the pharmacy benefit manager has paid the |
|
375
|
assessment.
|
|
376
|
(e) All fees assessed under this section and paid to the |
|
377
|
office shall be deposited into the Insurance Commissioner's |
|
378
|
Regulatory Trust Fund to provide all expenses for the |
|
379
|
regulation, supervision, and examination by the office of all |
|
380
|
entities subject to regulation under this section.
|
|
381
|
(f) If a pharmacy benefit manager becomes insolvent or |
|
382
|
ceases to do business in this state in any assessable or license |
|
383
|
year, the pharmacy benefit manager shall remain liable for the |
|
384
|
payment of the assessment for the period in which it operated as |
|
385
|
a pharmacy benefit manager in this state.
|
|
386
|
(10) PHARMACY BENEFIT MANAGER CONTRACTS.--
|
|
387
|
(a)1. A pharmacy benefit manager that contracts with a |
|
388
|
pharmacy or pharmacist to provide pharmacist's services in this |
|
389
|
state shall first inform the pharmacy or pharmacist in writing |
|
390
|
of the number of, and other relevant information concerning, |
|
391
|
patients to be served by the pharmacy or pharmacist under the |
|
392
|
contract.
|
|
393
|
2. There shall be a separate contract with each pharmacy |
|
394
|
or pharmacist for each of the pharmacy benefit manager's |
|
395
|
provider networks.
|
|
396
|
3. Contracts providing for indemnity of the pharmacy or |
|
397
|
pharmacist shall be separate from contracts providing for cash |
|
398
|
discounts.
|
|
399
|
4. A pharmacy benefit manager shall not require that a |
|
400
|
pharmacy or pharmacist participate in one contract in order to |
|
401
|
participate in another contract.
|
|
402
|
(b) Each pharmacy benefit manager shall provide contracts |
|
403
|
to the pharmacies and pharmacists that are written in plain |
|
404
|
English, using terms that will be generally understood by |
|
405
|
pharmacists.
|
|
406
|
(c) All contracts between a pharmacy benefit manager and a |
|
407
|
pharmacy or pharmacist shall provide specific time limits for |
|
408
|
the pharmacy benefit manager to pay the pharmacy or pharmacist |
|
409
|
for pharmacist's services rendered.
|
|
410
|
(d) No pharmacy benefit manager contract may mandate that |
|
411
|
any pharmacy or pharmacist change a patient's maintenance drug |
|
412
|
unless the prescribing practitioner so orders.
|
|
413
|
(e)1. In handling moneys received by the pharmacy benefit |
|
414
|
manager for pharmacist's services, the pharmacy benefit manager |
|
415
|
acts as a fiduciary of the pharmacy, pharmacist, or both, that |
|
416
|
provided the pharmacist's services.
|
|
417
|
2. A pharmacy benefit manager shall distribute all moneys |
|
418
|
the pharmacy benefit manager receives for pharmacist's services |
|
419
|
to the pharmacies and pharmacists that provided the pharmacist's |
|
420
|
services and shall do so within a time established by the |
|
421
|
office.
|
|
422
|
(f)1. A pharmacy benefit manager that contracts with a |
|
423
|
pharmacy or pharmacist to provide pharmacist's services in this |
|
424
|
state shall file the contract forms with the office 30 days |
|
425
|
before the execution of the contract.
|
|
426
|
2.a. The contract forms are approved unless the office |
|
427
|
disapproves the contract forms within 30 days after filing with |
|
428
|
the office.
|
|
429
|
b. Disapproval shall be in writing, stating the reasons |
|
430
|
for the disapproval, and a copy shall be delivered to the |
|
431
|
pharmacy benefit manager.
|
|
432
|
c. The office shall develop formal criteria for the |
|
433
|
approval and disapproval of pharmacy benefit manager contract |
|
434
|
forms.
|
|
435
|
(g)1. A pharmacy benefit manager that initiates an audit |
|
436
|
of a pharmacy or pharmacist under the contract shall limit the |
|
437
|
audit to methods and procedures that are recognized as fair and |
|
438
|
equitable for both the pharmacy benefit manager and the pharmacy |
|
439
|
or pharmacist, or both.
|
|
440
|
2. Extrapolation calculations in an audit are prohibited.
|
|
441
|
3. A pharmacy benefit manager may not recoup any moneys |
|
442
|
due from an audit by setoff from future remittances until the |
|
443
|
results of the audit are finalized.
|
|
444
|
(h) Before terminating a pharmacy or pharmacist from a |
|
445
|
pharmacy benefit manager's provider network, the pharmacy |
|
446
|
benefit manager shall give the pharmacy or pharmacist a written |
|
447
|
explanation of the reason for the termination 30 days before the |
|
448
|
actual termination unless the termination is taken in reaction |
|
449
|
to:
|
|
450
|
1. Loss of license;
|
|
451
|
2. Loss of professional liability insurance; or
|
|
452
|
3. Conviction of fraud or misrepresentation.
|
|
453
|
(i)1. No pharmacy or pharmacist may be held responsible |
|
454
|
for the acts or omissions of a pharmacy benefit manager.
|
|
455
|
2. No pharmacy benefit manager may be held responsible for |
|
456
|
the acts or omissions of a pharmacy or pharmacist.
|
|
457
|
(11) ENFORCEMENT.--
|
|
458
|
(a)1. Enforcement of this section shall be the |
|
459
|
responsibility of the board and the office.
|
|
460
|
2. The board or the office, or both, shall take action or |
|
461
|
impose appropriate penalties to bring a noncomplying pharmacy |
|
462
|
benefit manager into full compliance with this section or shall |
|
463
|
terminate the pharmacy benefit manager's certificate of |
|
464
|
authority or license.
|
|
465
|
(b)1. The board and the office shall each adopt procedures |
|
466
|
for formal investigation of complaints concerning the failure of |
|
467
|
a pharmacy benefit manager to comply with this section.
|
|
468
|
2.a. The office may refer a complaint received under this |
|
469
|
section to the board if the complaint involves a professional or |
|
470
|
patient health or safety issue.
|
|
471
|
b. The board may refer a complaint received under this |
|
472
|
section to the office if the complaint involves a business or |
|
473
|
financial issue.
|
|
474
|
3.a. If the board or the office has reason to believe that |
|
475
|
there may have been a violation of this section, the board or |
|
476
|
office shall issue and serve upon the pharmacy benefit manager a |
|
477
|
statement of the charges and a notice of a hearing.
|
|
478
|
b. The hearing shall be held at a time and place fixed in |
|
479
|
the notice, and not be less than 30 days after the notice is |
|
480
|
served.
|
|
481
|
c. At the hearing, the pharmacy benefit manager shall have |
|
482
|
an opportunity to be heard and to show cause why the board or |
|
483
|
the office should not:
|
|
484
|
(I) Issue a cease and desist order against the pharmacy |
|
485
|
benefit manager; or
|
|
486
|
(II) Take any other necessary or appropriate action, |
|
487
|
including, but not limited to, termination of the pharmacy |
|
488
|
benefit manager's certificate of authority or license.
|
|
489
|
(c)1. The board may conduct an investigation concerning |
|
490
|
the quality of services of any pharmacy benefit manager, |
|
491
|
pharmacy, or pharmacist with whom the pharmacy benefit manager |
|
492
|
has contracts, as the board deems necessary for the protection |
|
493
|
of the interests of the residents of this state.
|
|
494
|
2. In addition to applying penalties and remedies under |
|
495
|
this section for a pharmacy benefit manager's violation of this |
|
496
|
section, the board may also apply penalties and remedies under |
|
497
|
any provision of state law for violation thereof.
|
|
498
|
(12) MEDICATION REIMBURSEMENT COSTS.--
|
|
499
|
(a) Pharmacy benefit managers shall use a current |
|
500
|
nationally recognized benchmark to base reimbursements for |
|
501
|
medications and products dispensed by pharmacies or pharmacists |
|
502
|
with whom the pharmacy benefit manager contracts as follows:
|
|
503
|
1. For brand single-source drugs and brand multi-source |
|
504
|
drugs, either the Average Wholesale Price as listed in First |
|
505
|
Data Bank (Hearst Publications) or Facts & Comparisons (formerly |
|
506
|
Medispan) shall be used as an index.
|
|
507
|
2. For generic multi-source drugs, maximum allowable costs |
|
508
|
shall be established by referencing the Baseline Price as listed |
|
509
|
in either First Data Bank or Facts & Comparisons.
|
|
510
|
a. Only products that are in compliance with pharmacy laws |
|
511
|
as equivalent and generically interchangeable with a United |
|
512
|
States Food and Drug Administration Orange Book rating of A-B |
|
513
|
may be reimbursed from a maximum allowable cost price |
|
514
|
methodology.
|
|
515
|
b. If a generic multi-source drug product has no baseline |
|
516
|
price, then it shall be treated as a brand single-source drug |
|
517
|
for the purpose of valuing reimbursement.
|
|
518
|
(b) If the publications specified in paragraph (a) cease |
|
519
|
to be nationally recognized benchmarks used to base |
|
520
|
reimbursement for medications and products dispensed by |
|
521
|
pharmacies and pharmacists, other current nationally recognized |
|
522
|
benchmarks, as are then current and in effect, may be utilized |
|
523
|
so long as the benchmark is established and published by a |
|
524
|
person, business, or other entity with which no pharmacy benefit |
|
525
|
manager has a financial or business interest or connection.
|
|
526
|
(13) PROHIBITED PRACTICES.--
|
|
527
|
(a) Neither a pharmacy benefit manager nor a |
|
528
|
representative of a pharmacy benefit manager may cause or |
|
529
|
knowingly permit the use of any advertisement, promotion, |
|
530
|
solicitation, proposal, or offer that is untrue, deceptive, or |
|
531
|
misleading.
|
|
532
|
(b) A pharmacy benefit manager may not discriminate on the |
|
533
|
basis of race, creed, color, sex, or religion in the selection |
|
534
|
of pharmacies or pharmacists with which the pharmacy benefit |
|
535
|
manager contracts.
|
|
536
|
(c) A pharmacy benefit manager may not unreasonably |
|
537
|
discriminate against or between pharmacies or pharmacists.
|
|
538
|
(d) A pharmacy benefit manager shall be entitled to access |
|
539
|
a pharmacy's or pharmacist's usual and customary price only for |
|
540
|
comparison to specific claims for payment made by the pharmacy |
|
541
|
or pharmacist to the pharmacy benefit manager, and any other use |
|
542
|
or disclosure by the pharmacy benefit manager is prohibited.
|
|
543
|
(e) A pharmacy benefit manager may not, directly or |
|
544
|
indirectly, overtly or covertly, in cash or in kind, receive or |
|
545
|
accept any rebate, kickback, or any special payment, favor, or |
|
546
|
advantage of any valuable consideration or inducement for |
|
547
|
influencing or switching a patient's drug product unless the |
|
548
|
rebate, kickback, payment, favor, valuable consideration, or |
|
549
|
inducement is specified in a written contract that has been |
|
550
|
filed with the office.
|
|
551
|
(f)1. Claims for pharmacist's services paid by a pharmacy |
|
552
|
benefit manager may not be retroactively denied or adjusted |
|
553
|
after adjudication of the claims, unless:
|
|
554
|
a. The original claim was submitted fraudulently;
|
|
555
|
b. The original claim payment was incorrect because the |
|
556
|
pharmacy or pharmacist had already been paid for the |
|
557
|
pharmacist's services; or
|
|
558
|
c. The pharmacist's services were not, in fact, rendered |
|
559
|
by the pharmacy or pharmacist.
|
|
560
|
2. An acknowledgement of eligibility may not be |
|
561
|
retroactively reversed.
|
|
562
|
(g) A pharmacy benefit manager may not terminate a |
|
563
|
contract with a pharmacy or pharmacist, or terminate, suspend, |
|
564
|
or otherwise limit the participation of a pharmacy or pharmacist |
|
565
|
in a pharmacy benefit manager's provider network, because:
|
|
566
|
1. The pharmacy or pharmacist expresses disagreement with |
|
567
|
the pharmacy benefit manager's decision to deny or limit |
|
568
|
benefits to a patient;
|
|
569
|
2. The pharmacist discusses with a patient any aspect of |
|
570
|
the patient's medical condition or treatment alternatives;
|
|
571
|
3. The pharmacist makes personal recommendations regarding |
|
572
|
selecting a pharmacy benefit manager based on the pharmacist's |
|
573
|
personal knowledge of the health needs of the patient;
|
|
574
|
4. The pharmacy or pharmacist protests or expresses |
|
575
|
disagreement with a decision, policy, or practice of the |
|
576
|
pharmacy benefit manager;
|
|
577
|
5. The pharmacy or pharmacist has in good faith |
|
578
|
communicated with or advocated on behalf of any patient related |
|
579
|
to the needs of the patient regarding the method by which the |
|
580
|
pharmacy or pharmacist is compensated for services provided |
|
581
|
under the contract with the pharmacy benefit manager;
|
|
582
|
6. The pharmacy or pharmacist complains to the board or |
|
583
|
office that the pharmacy benefit manager has failed to comply |
|
584
|
with this section; or
|
|
585
|
7. The pharmacy or pharmacist asserts rights under the |
|
586
|
contract with the pharmacy benefit manager.
|
|
587
|
(h) Termination of a contract between a pharmacy benefit |
|
588
|
manager and a pharmacy or pharmacist, or termination of a |
|
589
|
pharmacy or pharmacist from a pharmacy benefit manager's |
|
590
|
provider network, shall not release the pharmacy benefit manager |
|
591
|
from the obligation to make any payment due to the pharmacy or |
|
592
|
pharmacist for pharmacist's services rendered.
|
|
593
|
(i) A pharmacy benefit manager may not intervene in the |
|
594
|
delivery or transmission of prescriptions from the prescriber to |
|
595
|
the pharmacist or pharmacy for the purpose of:
|
|
596
|
1. Influencing the prescriber's choice of therapy;
|
|
597
|
2. Influencing the patient's choice of pharmacist or |
|
598
|
pharmacy; or
|
|
599
|
3. Altering the prescription information, including, but |
|
600
|
not limited to, switching the prescribed drug without the |
|
601
|
express written authorization of the prescriber.
|
|
602
|
(j) A pharmacy benefit manager may not engage in or |
|
603
|
interfere with the practice of medicine or intervene in the |
|
604
|
practice of medicine between prescribers and their patients.
|
|
605
|
(k) A pharmacy benefit manager may not engage in any |
|
606
|
activity that violates any requirement of Florida law.
|
|
607
|
(14) NO IMPAIRMENT OF EXISTING CONTRACTS.--To avoid |
|
608
|
impairment of existing contracts, this section shall apply only |
|
609
|
to contracts entered into or renewed after the effective date of |
|
610
|
this section.
|
|
611
|
(15) SUPPLEMENTAL NATURE.--This section is supplemental to |
|
612
|
all other laws and supersedes only those laws or parts of laws |
|
613
|
in direct conflict with it.
|
|
614
|
Section 2. This act shall take effect upon becoming a law. |
|
615
|
|
|
616
|
|