Adopted Standing Committee by HCorporations
HB0035
Wyoming Pharmacy Benefit Manager Regulation Act
In one sentence
This law requires pharmacy benefit managers in Wyoming to be licensed and sets specific rules for how they audit pharmacies and determine drug prices.
What it does
- Requires pharmacy benefit managers to obtain a license from the Department of Insurance to operate in Wyoming.
- Establishes procedures for pharmacy benefit managers to audit pharmacies, including providing written notice at least 10 business days before an on-site audit.
- Limits the time period covered by audits to no more than two years from the date a claim was adjudicated.
- Prohibits pharmacy benefit managers from using extrapolation to calculate penalties or recoupments unless required by state or federal contracts.
- Requires that findings of overpayment or underpayment be based on actual amounts rather than projections based on similar patients or orders.
- Sets requirements for creating maximum allowable cost lists, such as ensuring drugs are rated 'A' or 'B' in the FDA's Orange Book or generally available from wholesalers.
- Establishes a timeline for delivering preliminary audit reports within 120 days and allows pharmacies at least 30 days to respond to findings.
Who it affects
- Pharmacy benefit managers operating in Wyoming.
- Pharmacies that have contracts with pharmacy benefit managers.
- The Wyoming Department of Insurance, which issues licenses and establishes rules.
- Insurers that provide health insurance coverage in the state.
Limits and unknowns
- The specific amount of the licensing fee is not listed in the provided text, only that a fee is required.
- The audit rules do not apply to audits involving suspected fraudulent activity or intentional misrepresentation.
- The audit rules do not apply to audits of claims paid for by federally funded programs.
- The rules apply to contracts entered into, renewed, or extended on or after July 1, 2016, and to all audits of pharmacies on and after July 1, 2017.
Plain language
Terms to know
- Pharmacy benefit manager
- An entity that contracts with a pharmacy on behalf of an insurer or third party administrator to administer or manage prescription drug benefits.
- Maximum allowable cost
- The maximum amount that a pharmacy benefit manager will reimburse a pharmacist or pharmacy for the cost of a generic drug.
- Audit
- A review of a pharmacy's records and claims conducted by a pharmacy benefit manager to check for overpayments or underpayments.
- Recoupment
- The recovery of funds that were overpaid or paid in error, which must occur after the final internal disposition of the audit including the appeals process.
Official record
Sources
Read the official summary
Summary for LSO115 Bill No.: HB0035 Effective : 7/1/2016 LSO No.: 16LSO-0191 Enrolled Act No.: HEA No. 0018 Chapter No.: 90 Prime Sponsor: Joint Corporations, Elections & Political Subdivisions Interim Committee Catch Title: Pharmacy benefit manager regulation. Subject: Regulati on of pharmacy benefit managers Summary/Major Elements: This bill regulate s pharmacy benefit managers whose job it is to manage and monitor prescription drug benefits, generally on behalf of insurance companies. The bill establishes procedures for licensing pharmacy benefit managers by the Department of Insurance. The bill regulate s audits perform ed by pharmacy benefit managers. The bill sets requirements for drug pricing and provide s and regulates the processes for pharmacies to appeal the actions of pharmacy benefit managers. The above summary is not an official publication of the Wyoming Legislature and is not an official statement of legislative intent. While the Legislative Service Office endeavored to provide accurate information in this summary, it should not be relied upon as a comprehensive abstract of the bill .
Public statements
Why lawmakers voted
Last checked Aug 7, 12:53 AM
Wyoming roll calls
Recorded votes
5 roll calls
S 3rd Reading:Passed 30-0-0-0-02016-02-29 · Senate30 yes 0 no
- Yes
- 30
- No
- 0
- Absent
- 0
- Excused
- 0
- Conflict
- 0
Yes 30
S07 - Corporations:Recommend Do Pass 5-0-0-0-02016-02-25 · Senate5 yes 0 no
- Yes
- 5
- No
- 0
- Absent
- 0
- Excused
- 0
- Conflict
- 0
H 3rd Reading:Passed 45-14-1-0-02016-02-18 · House45 yes 14 no
- Yes
- 45
- No
- 14
- Absent
- 0
- Excused
- 1
- Conflict
- 0
Yes 45
No 14
Excused 1
H07 - Corporations:Recommend Amend and Do Pass 8-0-1-0-02016-02-12 · House8 yes 0 no
- Yes
- 8
- No
- 0
- Absent
- 0
- Excused
- 1
- Conflict
- 0
H Introduced and Referred to H07 - Corporations 59-0-1-0-02016-02-09 · House59 yes 0 no
- Yes
- 59
- No
- 0
- Absent
- 0
- Excused
- 1
- Conflict
- 0
Yes 59
Excused 1
Official activity
Bill history
- Assigned Chapter NumberLSO
- Governor Signed HEA No. 0018Governor
- S President Signed HEA No. 0018Senate
- H Speaker Signed HEA No. 0018House
- Assigned Number HEA No. 0018LSO
- S 3rd Reading:Passed 30-0-0-0-0Senate
- S 2nd Reading:PassedSenate
- S COW:PassedSenate
- S Placed on General FileSenate
- S07 - Corporations:Recommend Do Pass 5-0-0-0-0Senate
- S Introduced and Referred to S07 - CorporationsSenate
- S Received for IntroductionSenate
- H 3rd Reading:Passed 45-14-1-0-0House
- H 2nd Reading:PassedHouse
- H COW:PassedHouse
- Amendment AdoptedHouse
- H Placed on General FileHouse
- H07 - Corporations:Recommend Amend and Do Pass 8-0-1-0-0House
- H Introduced and Referred to H07 - Corporations 59-0-1-0-0House
- H Received for IntroductionHouse
Changes
Amendments
1 stored