Pharmacy Benefit Prompt Pay Act and State Health Insurance Plan; revise.

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To: State Affairs
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Zuber

HOUSE BILL NO. 1665
(As Passed the House)

AN ACT TO REVISE THE PHARMACY BENEFIT PROMPT PAY ACT; TO 1
AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE 2
NEW SECTIONS ADDED TO THE PHARMACY BENEFIT PROMPT PAY ACT; TO 3
AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE NEW 4
TERMS AND REVISE THE DEFINITIONS OF CERTAIN EXISTING TERMS; TO 5
CREATE NEW SECTION 73-21-154, MISSISSIPPI CODE OF 1972, TO 6
TRANSFER ALL POWERS AND DUTIES EXERCISED BY THE STATE BOARD OF 7
PHARMACY UNDER THE PHARMACY BENEFIT PROMPT PAY ACT TO THE 8
COMMISSIONER OF INSURANCE; TO AMEND SECTION 73-21-155, MISSISSIPPI 9
CODE OF 1972, TO REVISE THE REIMBURSEMENT AMOUNT FROM PHARMACY 10
BENEFIT MANAGERS AND PHARMACY SERVICES ADMINISTRATIVE 11
ORGANIZATIONS (PSAOS) PAYABLE TO PHARMACIES; TO REQUIRE PHARMACY 12
BENEFIT MANAGERS TO GIVE PHARMACISTS REASONS FOR DENYING A CLAIM 13
WITHIN SEVEN DAYS OF RECEIVING AN ELECTRONIC CLAIM; TO AMEND 14
SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO DELETE PROVISIONS 15
AUTHORIZING PHARMACY BENEFIT MANAGERS TO USE MAXIMUM ALLOWABLE 16
COST LISTS; TO REVISE THE ADMINISTRATIVE APPEALS PROCESS PHARMACY 17
BENEFIT MANAGERS MUST MAKE AVAILABLE TO PHARMACIES TO CHALLENGE 18
REIMBURSEMENTS; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 19
1972, TO REQUIRE PSAOS TO BE LICENSED BY THE COMMISSIONER OF 20
INSURANCE; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO RENEW 21
LICENSES ANNUALLY; TO REVISE THE FINANCIAL DOCUMENTS THAT MUST BE 22
SUBMITTED TO THE COMMISSIONER WITH AN APPLICATION FOR A LICENSE OR 23
LICENSE RENEWAL; TO CREATE NEW SECTION 73-21-157.1, MISSISSIPPI 24
CODE OF 1972, TO CREATE A SPECIAL FUND IN THE STATE TREASURY TO 25
SUPPORT THE OPERATIONS OF THE DEPARTMENT OF INSURANCE IN THE 26
REGULATION OF PHARMACY BENEFIT MANAGERS; TO REQUIRE THE STATE 27
FISCAL OFFICER TO TRANSFER UNOBLIGATED FUNDS IN THE SPECIAL FUND 28
PREVIOUSLY USED BY THE STATE BOARD OF PHARMACY FOR THE REGULATION 29
OF PHARMACY BENEFIT MANAGERS TO THE NEW SPECIAL FUND; TO CREATE 30
NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT THE 31
USE OF SPREAD PRICING BY PHARMACY BENEFIT MANAGERS; TO AMEND 32
SECTION 73-21-159, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE 33
PROVISIONS OF THIS ACT; TO AMEND SECTION 73-21-161, MISSISSIPPI 34
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CODE OF 1972, TO PROHIBIT STEERING BY PHARMACY BENEFIT MANAGERS; 35
TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO 36
PROHIBIT RETALIATION AGAINST PHARMACISTS BY PHARMACY BENEFIT 37
MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PSAOS; TO AMEND 38
SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO REVISE PROVISIONS 39
RELATING TO INVESTIGATIONS AND AUDITS OF PHARMACY BENEFIT MANAGERS 40
CONDUCTED BY THE COMMISSIONER; TO CREATE NEW SECTION 73-21-165, 41
MISSISSIPPI CODE OF 1972, TO REQUIRE DRUG MANUFACTURERS, PHARMACY 42
BENEFIT MANAGERS, PSAOS AND HEALTH INSURERS TO SUBMIT CERTAIN 43
ANNUAL REPORTS TO THE COMMISSIONER; TO CREATE NEW SECTION 44
73-21-167, MISSISSIPPI CODE OF 1972, TO REQUIRE PLAN SPONSORS TO 45
DEVELOP CRITERIA AND A LIST OF PRESCRIPTION DRUGS DESIGNATED AS 46
SPECIALTY DRUGS; TO CREATE NEW SECTION 73-21-168, MISSISSIPPI CODE 47
OF 1972, TO REQUIRE THE COMMISSIONER TO DEVELOP A WEBSITE TO 48
PUBLISH CERTAIN INFORMATION RELATED TO THIS ACT; TO CREATE NEW 49
SECTION 73-21-169, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY 50
BENEFIT MANAGERS AND PSAOS TO IDENTIFY OWNERSHIP AFFILIATION OF 51
ANY KIND TO THE COMMISSIONER; TO AMEND SECTIONS 73-21-83 AND 52
73-21-91, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PRECEDING 53
PROVISIONS; TO AMEND SECTION 25-15-301, MISSISSIPPI CODE OF 1972, 54
TO REQUIRE THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE 55
MANAGEMENT BOARD TO SOLICIT REQUESTS FOR PROPOSALS FOR THE 56
ADMINISTRATION OF THE PLAN OR COMPONENTS OF THE PLAN EVERY TWO 57
YEARS; TO AUTHORIZE THE STATE AND SCHOOL EMPLOYEES LIFE AND HEALTH 58
INSURANCE PLAN TO CONTRACT FOR THE MANAGEMENT OF PHARMACY 59
BENEFITS; TO REQUIRE THE COMMISSIONER OF INSURANCE TO BE A MEMBER 60
OF THE EVALUATION COMMITTEE WHEN CONSIDERING PROPOSALS FOR SUCH 61
ADMINISTRATION; TO REQUIRE A PHARMACY BENEFITS MANAGER FOR THE 62
STATE HEALTH PLAN TO COMPLY WITH THE PROVISIONS OF THE PHARMACY 63
BENEFIT PROMPT PAY ACT; TO AMEND SECTION 25-15-303, MISSISSIPPI 64
CODE OF 1972, TO REVISE THE MEMBERSHIP OF THE STATE AND SCHOOL 65
EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD; TO CREATE NEW SECTION 66
25-15-305, MISSISSIPPI CODE OF 1972, TO REQUIRE THE STATE AND 67
SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD TO DEVELOP A 68
LIST OF PRESCRIPTION DRUGS THAT MEET THE CRITERIA ESTABLISHED BY 69
THE BOARD FOR SPECIALTY DRUG DESIGNATION; TO REQUIRE THE BOARD TO 70
CONSULT WITH THE ADMINISTRATORS OF THE PUBLIC EMPLOYEE HEALTH 71
PLANS IN THE CONTIGUOUS STATES TO DETERMINE THE FEASIBILITY OF 72
ENTERING INTO A JOINT AGREEMENT TO COMBINE PURCHASING POWER FOR 73
PHARMACEUTICALS; TO AMEND SECTION 25-15-11, MISSISSIPPI CODE OF 74
1972, IN CONFORMITY TO THE PROVISIONS OF THIS ACT; TO BRING 75
FORWARD SECTIONS 25-15-3, 25-15-5, 25-15-7, 25-15-9, 25-15-13, 76
25-15-14, 25-15-15, 25-15-16, 25-15-17, 25-15-19 AND 25-15-23, 77
MISSISSIPPI CODE OF 1972, WHICH RELATE TO THE STATE EMPLOYEES LIFE 78
AND HEALTH INSURANCE PLAN, FOR THE PURPOSE OF POSSIBLE AMENDMENT; 79
TO BRING FORWARD SECTIONS 41-149-5, 41-151-7 AND 73-21-205, 80
MISSISSIPPI CODE OF 1972, FOR THE PURPOSE OF POSSIBLE AMENDMENT; 81
TO PROVIDE FOR SEVERABILITY; TO CREATE NEW SECTION 73-21-171, 82
MISSISSIPPI CODE OF 1972, TO PROVIDE FOR THE REPEAL OF THE 83
PHARMACY BENEFIT PROMPT PAY ACT; TO CREATE NEW SECTION 25-15-307, 84
MISSISSIPPI CODE OF 1972, TO PROVIDE FOR THE REPEAL OF THOSE 85
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SECTIONS RELATING TO THE ADMINISTRATION OF THE PUBLIC EMPLOYEE 86
HEALTH PLANS; AND FOR RELATED PURPOSES. 87
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 88
SECTION 1. Section 73-21-151, Mississippi Code of 1972, is 89
amended as follows: 90
73-21-151. Sections 73-21-151 through * * * 73-21-169 shall 91
be known as the "Pharmacy Benefit Prompt Pay Act." 92
SECTION 2. Section 73-21-153, Mississippi Code of 1972, is 93
amended as follows: 94
73-21-153. For purposes of Sections 73-21-151 through * * * 95
73-21-169, the following words and phrases shall have the meanings 96
ascribed herein unless the context clearly indicates otherwise: 97
(a) "Board" means the State Board of Pharmacy. 98
(b) "Clean claim" means a completed billing instrument, 99
paper or electronic, received by a pharmacy benefit manager from a 100
pharmacist or pharmacies or the insured, which is accepted and 101
payment remittance advice is provided by the pharmacy benefit 102
manager. The term "clean claim" includes resubmitted claims with 103
previously identified deficiencies corrected. 104
(c) "Commissioner" means the Mississippi Commissioner 105
of Insurance. 106
( * * *d) "Day" means a calendar day, unless otherwise 107
defined or limited. 108
(e) "Drug" has the same definition as provided in 109
Section 73-21-73. 110
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( * * *f) "Electronic claim" means the transmission of 111
data for purposes of payment of covered prescription drugs, other 112
products and supplies, and pharmacist services in an electronic 113
data format specified by a pharmacy benefit manager and approved 114
by the department. 115
( * * *g) "Electronic adjudication" means the process 116
of electronically receiving * * * and reviewing an electronic 117
claim and either accepting and providing payment remittance advice 118
for the electronic claim or rejecting * * * the electronic claim. 119
( * * *h) "Enrollee" means an individual who has been 120
enrolled in a pharmacy benefit management plan or health insurance 121
plan. 122
( * * *i) "Health insurance plan" means benefits 123
consisting of prescription drugs, other products and supplies, and 124
pharmacist services provided directly, through insurance or 125
reimbursement, or otherwise and including items and services paid 126
for as prescription drugs, other products and supplies, and 127
pharmacist services under any hospital or medical service policy 128
or certificate, hospital or medical service plan contract, 129
preferred provider organization agreement, or health maintenance 130
organization contract offered by a health insurance issuer. 131
(j) "Network pharmacy" means a pharmacy licensed by the 132
state which provides pharmacy services to Mississippi consumers 133
and has a contract with a pharmacy benefit manager to provide 134
covered drugs at a negotiated reimbursement rate. 135
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(k) "Payment remittance advice" means the claim detail 136
that the pharmacy receives when successfully processing an 137
electronic or paper claim. The claim detail must contain, but is 138
not limited to: 139
(i) The amount that the pharmacy benefit manager 140
or PSAO will reimburse for product ingredient; and 141
(ii) The amount that the pharmacy benefit manager 142
or PSAO will reimburse for product dispensing fee; and 143
(iii) The amount that the pharmacy benefit manager 144
or health insurance plan dictates the patient must pay. 145
(l) "Pharmacist" has the same definition as provided in 146
Section 73-21-73. 147
(m) "Pharmacy" has the same definition as provided in 148
Section 73-21-73. 149
(n) "Pharmacy acquisition cost" means the amount that a 150
pharmaceutical wholesaler charges for a pharmaceutical product as 151
listed on the pharmacy's billing invoice. 152
( * * *o) "Pharmacy benefit manager" * * * means an 153
entity that provides pharmacy benefit management services. The 154
term "pharmacy benefit manager" shall not include: 155
(i) An insurance company unless the insurance 156
company is providing services as a pharmacy benefit manager * * *, 157
in which case the insurance company shall be subject to * * * this 158
act only for those pharmacy benefit manager services * * *; or 159
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(ii) The Mississippi Division of Medicaid or its 160
contractors when performing pharmacy benefit manager services for 161
the Division of Medicaid. 162
( * * *p) "Pharmacy benefit manager affiliate" 163
means * * * an entity that, directly or indirectly, * * * owns or 164
controls, is owned or controlled by, or is under common ownership 165
or control with a pharmacy benefit manager. 166
( * * *q) "Pharmacy benefit management plan" * * * 167
means an arrangement for the delivery of pharmacist's services in 168
which a pharmacy benefit manager undertakes to administer the 169
payment or reimbursement of any of the costs of pharmacist's 170
services, drugs or devices. 171
(r) "Pharmacy benefit management services" includes, 172
but is not limited to, the following services, which may be 173
provided either directly or through outsourcing or contracts: 174
(i) Adjudicate drug claims or any portion of the 175
transaction; 176
(ii) Contract with retail and mail pharmacy 177
networks; 178
(iii) Establish payment levels for pharmacies; 179
(iv) Develop formularies or drug lists of covered 180
therapies; 181
(v) Provide benefit design consultation; 182
(vi) Manage cost and utilization trends; 183
(vii) Contract for manufacturer rebates; 184
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(viii) Provide fee-based clinical services to 185
improve member care; 186
(ix) Third-party administration; and 187
(x) Sponsoring or providing cash discount cards, 188
as defined in Section 83-9-6.1, and electronic discount cards. 189
(s) "Pharmacist services" means products, goods and 190
services, or any combination of products, goods and services, 191
provided as part of the practice of pharmacy. 192
(t) "Pharmacy services administrative organization" or 193
"PSAO" means an entity that contracts with a pharmacy or 194
pharmacist to assist with third-party payer interactions and which 195
may provide a variety of other administrative services, including, 196
but not limited to, contracting with third-party payers or 197
pharmacy benefit managers on behalf of pharmacies and providing 198
pharmacies or pharmacists with credentialing, billing, audit, 199
general business and analytic support. A covered entity, as 200
defined in 42 USC Section 256b, including its pharmacy or the 201
transactions related to the 340B drug discount program of a 202
pharmacy contracted with the participating covered entity to 203
dispense drugs purchased through the 340B drug discount program, 204
is not considered to be a pharmacy services administrative 205
organization. 206
(u) "Plan sponsors" means the employers, insurance 207
companies, unions and health maintenance organizations that 208
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contract, either directly or indirectly, with a pharmacy benefit 209
manager for delivery of prescription drugs or services, or both. 210
(v) "Proprietary information" means information on 211
pricing, costs, revenue, taxes, market share, negotiating 212
strategies, customers and personnel that is held by a pharmacy 213
benefit manager or PSAO and used for its business purposes. 214
(w) "Rebate" means any and all payments and price 215
concessions that accrue to a pharmacy benefit manager or its plan 216
sponsor client, directly or indirectly, including through an 217
affiliate, subsidiary, third party or intermediary, including 218
off-shore group purchasing organizations, from a pharmaceutical 219
manufacturer, its affiliate, subsidiary, third party or 220
intermediary, including, but not limited to, payments, discounts, 221
administration fees, credits, incentives, price concessions or 222
penalties associated, directly or indirectly, in any way with 223
claims administered on behalf of a plan sponsor. 224
(x) "Spread pricing" means an amount charged or claimed 225
by a pharmacy benefit manager or PSAO in excess of the ingredient 226
cost for a dispensed prescription drug plus dispensing fee paid 227
directly or indirectly to a pharmacy, pharmacist or other provider 228
on behalf of the health benefit plan. 229
* * * 230
( * * *y) "Uniform claim form" means a form prescribed 231
by rule by the * * * commissioner; however, for purposes of * * * 232
this act, the * * * commissioner shall adopt the same definition 233
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or rule where the State Department of Insurance already has 234
adopted a rule covering the same type of claim. The * * * 235
commissioner may modify the terminology of the rule and form when 236
necessary to comply with the provisions of * * * this act. 237
(z) "Wholesale acquisition cost" means the wholesale 238
acquisition cost of the drug as defined in 42 USC Section 239
1395w-3a(c)(6)(B). 240
* * * 241
SECTION 3. The following shall be codified as Section 73-21-242
154, Mississippi Code of 1972: 243
73-21-154. (1) Beginning on July 1, 2026, all powers and 244
duties vested in and exercised by the State Board of Pharmacy 245
before July 1, 2026, in the regulation of pharmacy benefit 246
managers under the provisions of the Pharmacy Benefit Prompt Pay 247
Act are transferred to the Commissioner of Insurance, and 248
beginning on July 1, 2026, all such powers and duties shall be 249
exercised by the Commissioner of Insurance. Any reference to the 250
State Board of Pharmacy in any provision of law or in any rule, 251
regulation or document pertaining to the regulation of pharmacy 252
benefit managers means the Commissioner of Insurance. 253
(2) Beginning on July 1, 2026, the commissioner shall be 254
responsible for the regulation of pharmacy benefit managers and 255
pharmacy services administrative organizations, as defined in 256
Section 73-21-153. 257
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SECTION 4. Section 73-21-155, Mississippi Code of 1972, is 258
amended as follows: 259
73-21-155. (1) (a) Reimbursement * * * to a pharmacist or 260
pharmacy by a pharmacy benefit manager or PSAO for the dispensing 261
of a prescription drug * * * and other products and supplies * * * 262
shall be a net amount not less than the pharmacy acquisition cost. 263
(b) A contract for pharmacy benefit management services 264
must include a provision establishing that the reimbursements made 265
under paragraph (a) of this subsection (1) shall be a net amount 266
not less than the pharmacy acquisition cost. 267
(2) * * * (a) All benefits payable * * * from a pharmacy 268
benefit * * * manager or PSAO shall be paid within seven (7) days 269
after receipt of * * * a clean electronic claim where * * * the 270
claim was electronically adjudicated, and shall be paid within 271
thirty-five (35) days after receipt of due written proof of a 272
clean claim where claims are submitted in paper format. 273
Benefits * * * are overdue if not paid within seven (7) days or 274
thirty-five (35) days, whichever is applicable, after the pharmacy 275
benefit manager receives a clean claim containing necessary 276
information essential for the pharmacy benefit manager to 277
administer preexisting condition, coordination of benefits and 278
subrogation provisions under the plan sponsor's * * * plan. * * * 279
* * * 280
( * * *b) * * * If an electronic claim is denied, the 281
pharmacy benefit manager shall * * * notify the pharmacist or 282
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pharmacy * * * within seven (7) days of the reasons why the claim 283
or portion thereof is not clean and will not be paid and what 284
substantiating documentation and information is required to 285
adjudicate the claim as clean. * * * If a written claim is 286
denied, the pharmacy benefit manager shall notify the pharmacy or 287
pharmacies no later than thirty-five (35) days * * * of receipt of 288
the claim * * *. The pharmacy benefit manager shall * * * notify 289
the pharmacist or pharmacy * * * of the reasons why the claim or 290
portion thereof is not clean and will not be paid and what 291
substantiating documentation and information is required to 292
adjudicate the claim as clean. Any claim or portion thereof 293
resubmitted with the supporting documentation and information 294
requested by the pharmacy benefit manager shall be paid within 295
twenty (20) days after receipt. 296
( * * *3) If the * * * commissioner finds that any pharmacy 297
benefit manager, PSAO, agent or other party responsible for 298
reimbursement for prescription drugs and other products and 299
supplies has not paid ninety-five percent (95%) of clean claims, 300
as defined in * * * Section 73-21-153, received from all 301
pharmacies in a calendar quarter, * * * the pharmacy benefit 302
manager, PSAO, agent or other party shall be subject to an 303
administrative penalty of not more than Twenty-five Thousand 304
Dollars ($25,000.00) to be assessed by the * * * commissioner and 305
deposited into the special fund used by the commissioner to 306
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support the operations of the commissioner relating to the 307
regulation of pharmacy benefit managers. 308
(a) Examinations to determine compliance with 309
this * * * section may be conducted by the * * * commissioner. 310
The * * * commissioner may contract with qualified impartial 311
outside sources to assist in examinations to determine compliance. 312
* * * 313
(b) Nothing in the provisions of this section shall 314
require a pharmacy benefit manager to pay claims that are not 315
covered under the terms of a contract * * *, plan, policy of 316
accident and sickness insurance or prepaid coverage. 317
* * * 318
( * * *c) Any pharmacy benefit manager * * * may enter 319
into an express written agreement * * * with a pharmacy or PSAO on 320
behalf of a pharmacy that contains timely claim payment provisions 321
which differ from, but are at least as stringent as, the 322
provisions set forth under subsection ( * * *2) of this section, 323
and in such case, the provisions of the written agreement shall 324
govern the timely payment of claims by the pharmacy benefit 325
manager or PSAO to the pharmacy. If the express written agreement 326
is silent as to any interest penalty where claims are not paid in 327
accordance with the agreement, the interest penalty provision of 328
subsection (4) * * * of this section shall apply. 329
( * * *d) The * * * commissioner may adopt rules and 330
regulations necessary to ensure compliance with this subsection. 331
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( * * *4) If a clean claim is not paid or is denied without 332
providing to the pharmacy a valid and proper reason as to why the 333
claim is not clean by the end of the applicable time period 334
prescribed in this section, the pharmacy benefit manager must pay 335
the pharmacy (when the claim is owed to the pharmacy) or the 336
patient (when the claim is owed to a patient) interest on accrued 337
benefits at the rate of one and one-half percent (1-1/2%) per 338
month accruing from the day after payment was due on the amount of 339
the benefits that remain unpaid until the claim is finally settled 340
or adjudicated. Whenever interest due pursuant to this subsection 341
is less than One Dollar ($1.00), such amount shall be credited to 342
the account of the person or entity to whom such amount is owed. 343
(5) (a) * * * A network pharmacy or pharmacist may decline 344
to provide a brand name drug, * * * generic drug, biosimilar drug 345
or service, if the network pharmacy or pharmacist is paid less 346
than that network pharmacy's acquisition cost for the * * * 347
prescription. If the network pharmacy or pharmacist declines to 348
provide such drug or service, the pharmacy or pharmacist shall 349
provide the customer with adequate information as to where the 350
prescription for the drug or service may be filled. A pharmacy 351
benefit manager may not require a pharmacy or pharmacist to submit 352
a claim for payment through a plan of the patient when the patient 353
requests to pay for the prescription drug with cash or an 354
alternative payment method. 355
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(b) The * * * commissioner shall adopt rules and 356
regulations necessary to implement and ensure compliance with this 357
subsection, including, but not limited to, rules and regulations 358
that address access to pharmacy services in rural or underserved 359
areas and also in cases where a network pharmacy or pharmacist 360
declines to provide a drug or service under paragraph (a) of this 361
subsection. * * * 362
(6) A pharmacy benefit manager or PSAO shall not directly or 363
indirectly retroactively deny or reduce a claim or aggregate of 364
claims after the claim or aggregate of claims has been 365
adjudicated. 366
(7) A pharmacy benefit manager or PSAO may not impose a fee 367
or otherwise adjust or lower the reimbursement of a claim at the 368
time the claim is adjudicated, or after the claim is adjudicated, 369
which reduces the amount of the reimbursement for the claim. 370
SECTION 5. Section 73-21-156, Mississippi Code of 1972, is 371
amended as follows: 372
73-21-156. (1) * * * A pharmacy benefit manager shall: 373
(a) Provide a reasonable administrative appeal 374
procedure to allow pharmacies to challenge * * * reimbursements 375
made * * * for a specific drug or drugs as: 376
(i) Not meeting the requirements of this section; 377
or 378
(ii) * * * Being below the reimbursement rate 379
required under subsection (1) of Section 73-21-155. 380
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(b) The reasonable administrative appeal procedure 381
shall include the following: 382
(i) A * * * telephone number * * * and email 383
address * * * on the main page of the website of the pharmacy 384
benefit manager which provides direct access to the claim appeals 385
department; 386
(ii) The pharmacy benefit manager shall provide a 387
detailed written response within seven (7) days of receipt of an 388
email or telephone call from a pharmacist or pharmacy regarding an 389
issue with an administrative appeal; 390
(iii) The website of the pharmacy benefit manager 391
must include easily accessible administrative appeal instructions 392
and list any other required information to be submitted by 393
pharmacies for the purpose of submitting administrative appeals; 394
(iv) The ability to submit * * * a single 395
administrative appeal or a claim appeal report for multiple claims 396
directly to the pharmacy benefit manager * * * or through a * * * 397
PSAO; and 398
( * * *v) A period of no less than thirty 399
(30) * * * days to file an administrative appeal. 400
(c) The pharmacy benefit manager shall respond to the 401
challenge under * * * this subsection * * * within thirty 402
(30) * * * days after receipt of the challenge. 403
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(d) If a challenge is made under * * * this 404
subsection * * *, the pharmacy benefit manager shall, within 405
thirty (30) * * * days after receipt of the challenge, either: 406
(i) * * * Uphold the appeal * * * and: 407
1. * * * Adjust the reimbursement or 408
reimbursements paid to the pharmacist or pharmacy to the amount 409
required under subsection (1) of Section 73-21-155; and 410
2. Permit the challenging pharmacy or 411
pharmacist to reverse and rebill the claim in question; and 412
* * * 413
* * *3. Make the * * * adjustment for that 414
National Drug Code effective for * * * the pharmacy * * * that 415
filed the claim for a time period of no less than ninety (90) days 416
from the date the claim appeal was upheld; or 417
(ii) * * * Deny the appeal * * * and provide the 418
reason for the denial in writing to the challenging pharmacy or 419
pharmacist * * *. 420
(e) The commissioner may adopt rules and regulations 421
necessary to ensure compliance with this subsection. 422
(2) A pharmacy benefit manager may not deny an appeal 423
submitted pursuant to this section based upon an existing 424
contracted rate with the pharmacy. 425
(3) A pharmacy or pharmacist that belongs to a PSAO must be 426
provided a true and correct copy of a contract and contract 427
amendment that the PSAO enters into with a pharmacy benefit 428
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manager or third-party payer on the pharmacy's or pharmacist's 429
behalf. 430
( * * *4) * * * A pharmacy benefit manager or PSAO shall not 431
reimburse a pharmacy or pharmacist in the state an amount less 432
than the amount that the pharmacy benefit manager reimburses a 433
pharmacy benefit manager affiliate for providing the * * * drug, 434
and the amount reimbursed may not be less than the amount 435
prescribed pursuant to subsection (1) of Section 73-21-155. 436
* * * The reimbursement amount for a drug shall be 437
calculated on a per unit basis based on the same brand and generic 438
product identifier or brand and generic code number. 439
(5) The pharmacy benefit manager or PSAO may not require a 440
pharmacy to collect additional monies following a successful 441
below-cost reimbursement appeal from a person or entity other than 442
the pharmacy benefit manager who adjudicated the drug claim, 443
including the patient or plan sponsor. 444
SECTION 6. Section 73-21-157, Mississippi Code of 1972, is 445
amended as follows: 446
73-21-157. (1) Before beginning to do business as a 447
pharmacy benefit manager or PSAO, a pharmacy benefit manager or 448
PSAO shall obtain a license to do business from the * * * 449
commissioner. To obtain a license, the applicant shall submit an 450
application to the * * * commissioner on a form to be prescribed 451
by the * * * commissioner. The license must be renewed annually. 452
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(2) When applying for a license or renewal of a license, 453
each pharmacy benefit manager * * * shall file * * * with 454
the * * * commissioner: 455
(a) (i) A copy of a certified audit report, if the 456
pharmacy benefit manager has been audited by a certified public 457
accountant within the last twenty-four (24) months; or 458
(ii) If the pharmacy benefit manager has not been 459
audited in the last twenty-four (24) months, a financial statement 460
of the organization, including its balance sheet and income 461
statement for the preceding year which is verified by at least two 462
(2) principal officers; and 463
(b) Any other information relating to the operations of 464
the pharmacy benefit manager or PSAO required by the * * * 465
commissioner. 466
( * * *3) (a) Any information required to be submitted to 467
the * * * commissioner pursuant to licensure application that is 468
considered proprietary by a pharmacy benefit manager or PSAO shall 469
be marked as confidential when submitted to the * * * 470
commissioner. All such information shall not be subject to the 471
provisions of the federal Freedom of Information Act or the 472
Mississippi Public Records Act and shall not be released by 473
the * * * commissioner unless subject to an order from a court of 474
competent jurisdiction. The * * * commissioner shall destroy or 475
delete or cause to be destroyed or deleted all such information 476
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thirty (30) days after the * * * commissioner determines that the 477
information is no longer necessary or useful. 478
(b) Any person who knowingly releases, causes to be 479
released or assists in the release of any such information shall 480
be subject to a monetary penalty imposed by the * * * commissioner 481
in an amount not exceeding Fifty Thousand Dollars ($50,000.00) per 482
violation. * * * Any penalty collected under this paragraph (b) 483
shall be deposited into the special fund * * * used to support the 484
operations of the * * * commissioner relating to the regulation of 485
pharmacy benefit managers. 486
(c) All employees of the * * * Department of Insurance 487
who have access to the information described in paragraph (a) of 488
this subsection shall be fingerprinted, and the * * * commissioner 489
shall submit a set of fingerprints for each employee to the 490
Department of Public Safety for the purpose of conducting a 491
criminal history records check. If no disqualifying record is 492
identified at the state level, the Department of Public Safety 493
shall forward the fingerprints to the Federal Bureau of 494
Investigation for a national criminal history records check. 495
( * * *4) * * * The * * * commissioner may waive the 496
requirements for filing financial information for the pharmacy 497
benefit manager if an affiliate of the pharmacy benefit manager is 498
already required to file such information under current law with 499
the commissioner * * *. 500
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( * * *5) The expense of administering this section shall be 501
assessed annually by the * * * commissioner against all pharmacy 502
benefit managers and PSAOs operating in this state. 503
(6) The initial licensure fee and the renewal license fee 504
for pharmacy benefit managers and pharmacy services administrative 505
organizations shall be set by the commissioner but shall not 506
exceed Five Hundred Dollars ($500.00). 507
( * * *7) A pharmacy benefit manager, PSAO or third-party 508
payor * * * shall not require pharmacy accreditation standards 509
or * * * certification requirements inconsistent with, more 510
stringent than, or in addition to federal and state requirements 511
for licensure as a pharmacy in this state. 512
SECTION 7. The following shall be codified as Section 73-21-513
157.1, Mississippi Code of 1972: 514
73-21-157.1. There is created in the State Treasury a 515
special fund to be administered and utilized by the Commissioner 516
of Insurance to support the operations of the Department of 517
Insurance relating to the regulation of pharmacy benefit managers. 518
Beginning on July 1, 2026, all funds that would have been 519
appropriated to or otherwise deposited in the special fund under 520
Sections 73-21-151 through 73-21-169 and monies from any other 521
source designated for deposit into the fund used by the State 522
Board of Pharmacy for the regulation of pharmacy benefit managers 523
shall be deposited into the special fund created under this 524
section. No later than July 10, 2026, the State Fiscal Officer 525
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shall transfer all unobligated funds in the special fund used by 526
the State Board of Pharmacy to the special fund created under this 527
section. Unexpended amounts remaining in the special fund at the 528
end of a fiscal year shall not lapse into the State General Fund, 529
and any interest earned or investment earnings on amounts in the 530
fund shall be deposited to the credit of the fund. 531
SECTION 8. The following shall be codified as Section 532
73-21-158, Mississippi Code of 1972: 533
73-21-158. (1) A pharmacy benefit manager is prohibited 534
from engaging in spread pricing. Separately identified 535
administrative fees or costs are exempt from this requirement, if 536
mutually agreed upon in writing by the payor and pharmacy benefit 537
manager. 538
(2) A pharmacy benefit manager or third-party payer may not 539
charge or cause a patient to pay an amount that exceeds the total 540
amount retained by the pharmacy. 541
(3) Every pharmacy benefit manager and PSAO shall disclose 542
and pass on to the plan sponsor or employer one hundred percent 543
(100%) of all rebates and other payments that the pharmacy benefit 544
manager or PSAO receives directly or indirectly from 545
pharmaceutical manufacturers and/or rebate aggregators in 546
connection with claims administered on behalf of the plan sponsor 547
or employer and the recipients of such rebates. In addition, a 548
pharmacy benefit manager or PSAO shall report annually to each 549
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plan sponsor or employer the aggregate amount of all rebates and 550
other payments and the recipients of such rebates. 551
(4) A pharmacy benefit manager or PSAO may not charge a 552
pharmacist or pharmacy a fee related to the adjudication of a 553
claim, including, without limitation, a fee for: 554
(a) The submission or processing of a claim; 555
(b) The adjudication of a claim; 556
(c) Enrollment or participation in a pharmacy network; 557
or 558
(d) The development or management of claims processing 559
services or claims payment services related to participation in a 560
pharmacy network. 561
(5) A pharmacy benefit manager or PSAO shall not charge a 562
pharmacist or pharmacy a fee related to participation in a 563
pharmacy network, including, but not limited to, the following: 564
(a) An application fee; 565
(b) An enrollment or participation fee; 566
(c) A credentialing or re-credentialing fee; 567
(d) A change of ownership fee; or 568
(e) A fee for the development or management of claims 569
processing services or claims payment services. 570
SECTION 9. Section 73-21-159, Mississippi Code of 1972, is 571
amended as follows: 572
73-21-159. (1) In lieu of or in addition to making its own 573
financial examination of a pharmacy benefit manager, the * * * 574
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commissioner may accept the report of a financial examination of 575
other persons responsible for the pharmacy benefit manager under 576
the laws of another state certified by the applicable official of 577
such other state. 578
(2) The * * * commissioner shall coordinate financial 579
examinations of a pharmacy benefit manager that provides pharmacy 580
management benefit plans in this state to ensure an appropriate 581
level of regulatory oversight and to avoid any undue duplication 582
of effort or regulation. The pharmacy benefit manager being 583
examined shall pay the cost of the examination. The cost of the 584
examination shall be deposited in a special fund that shall 585
provide all expenses for the licensing, supervision and 586
examination of all pharmacy benefit managers subject to regulation 587
under Sections 73-21-71 through 73-21-129 and Sections 73-21-151 588
through * * * 73-21-169. 589
(3) The * * * commissioner may provide a copy of the 590
financial examination to the person or entity who provides or 591
operates the health insurance plan or to a pharmacist or pharmacy. 592
(4) The * * * commissioner is authorized to hire independent 593
financial consultants to conduct financial examinations of a 594
pharmacy benefit manager and to expend funds collected under this 595
section to pay the costs of such examinations. 596
SECTION 10. Section 73-21-161, Mississippi Code of 1972, is 597
amended as follows: 598
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73-21-161. (1) As used in this section, the term * * * 599
"steering" means: 600
(a) * * * Directing, ordering or requiring a patient to 601
use a specific affiliate pharmacy or pharmacies for the purpose of 602
filling a prescription or receiving services or other care from a 603
pharmacist; 604
(b) Offering or implementing plan designs that require 605
a patient to utilize an affiliate pharmacy or pharmacies, or that 606
increase costs to a patient, including, but not limited to, 607
requiring a patient to pay the full cost for a prescription drug 608
when the patient chooses not to use a pharmacy benefit manager 609
affiliate pharmacy; 610
(c) Advertising, marketing or promoting an affiliate 611
pharmacy or pharmacies over another in-network pharmacy, but * * * 612
does not include a pharmacy's inclusion by a pharmacy benefit 613
manager or pharmacy benefit manager affiliate in communications to 614
patients, including patient and prospective patient specific 615
communications, regarding network pharmacies and prices, provided 616
that the pharmacy benefit manager or pharmacy benefit manager 617
affiliate includes information regarding eligible nonaffiliate 618
pharmacies in those communications and the information provided is 619
accurate * * *; 620
(d) Creating a network or engaging in a practice, 621
including accreditation or credentialing standards, day supply 622
requirements or delivery methods requirements, which excludes an 623
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in-network pharmacy or restricts an in-network pharmacy from 624
filling a prescription for a prescription drug; or 625
(e) Directly or indirectly engaging in a practice that 626
attempts to influence or induce a pharmaceutical manufacturer to 627
limit the distribution of a prescription drug to a small number of 628
pharmacies or certain types of pharmacies, or to restrict 629
distribution of that drug to nonaffiliate pharmacies. 630
(2) A pharmacy, pharmacy benefit manager, or pharmacy 631
benefit manager affiliate licensed or operating in Mississippi 632
shall be prohibited from: 633
(a) * * * Steering; 634
(b) Transferring or sharing records relative to 635
prescription information containing patient identifiable and 636
prescriber identifiable data to or from a pharmacy benefit manager 637
affiliate for any commercial purpose; however, nothing in this 638
section shall be construed to prohibit the exchange of 639
prescription information between a pharmacy and its affiliate for 640
the limited purposes of: pharmacy reimbursement; formulary 641
compliance; pharmacy care; public health activities otherwise 642
authorized by law; or utilization review by a health care 643
provider; * * * 644
(c) Presenting a claim for payment to any individual, 645
third-party payor, affiliate, or other entity for a prescription 646
drug or service furnished * * * by steering from * * * a pharmacy 647
benefit manager or pharmacy benefit manager affiliate * * *; or 648
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(d) Interfering with the patient's right to choose the 649
patient's pharmacy or provider of choice, including inducement, 650
required referrals or offering financial or other incentives or 651
measures that would constitute a violation of Section 83-9-6. 652
(3) This section shall not be construed to prohibit a 653
pharmacy from entering into an agreement with a pharmacy benefit 654
manager or pharmacy benefit manager affiliate to provide pharmacy 655
care to patients, provided that neither the pharmacy * * * nor the 656
pharmacy benefit manager affiliate violates subsection (2) of this 657
section and the pharmacy provides the disclosures required in 658
subsection (1) of this section. 659
* * * 660
( * * *4) In addition to any other remedy provided by law, a 661
violation of this section by a pharmacy, pharmacy benefit manager 662
or pharmacy benefit manager affiliate shall be grounds for 663
disciplinary action by the * * * commissioner under its authority 664
granted in this chapter. 665
( * * *5) A pharmacist who fills a prescription that 666
violates subsection (2) of this section shall not be liable under 667
this section. 668
(6) This section does not apply to facilities licensed to 669
fill prescriptions solely for employees of a plan sponsor or 670
employer. 671
SECTION 11. The following shall be codified as Section 672
73-21-162, Mississippi Code of 1972: 673
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73-21-162. (1) (a) Retaliation is prohibited. 674
(b) A pharmacy benefit manager, pharmacy benefit 675
manager affiliate or PSAO may not retaliate against a pharmacist 676
or pharmacy based on the pharmacist's or pharmacy's exercise of a 677
right or remedy under this chapter. Retaliation prohibited by 678
this section includes, but is not limited to: 679
(i) Terminating or refusing to renew a contract 680
with the pharmacist or pharmacy; 681
(ii) Subjecting the pharmacist or pharmacy to an 682
increased frequency of audits, number of claims audited, or amount 683
of monies for claims audited; or 684
(iii) Failing to promptly pay the pharmacist or 685
pharmacy money owed by the pharmacy benefit manager to the 686
pharmacist or pharmacy. 687
(c) For the purposes of this section, a pharmacy 688
benefit manager, pharmacy benefit manager affiliate or PSAO is not 689
considered to have retaliated against a pharmacy if the pharmacy 690
benefit manager: 691
(i) Takes an action in response to a credible 692
allegation of fraud against the pharmacist or pharmacy; and 693
(ii) Provides reasonable notice and a reasonable 694
opportunity to respond to the pharmacist or pharmacy of the 695
allegation of fraud and the basis of the allegation before 696
initiating an action. 697
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(2) A pharmacy benefit manager, pharmacy benefit manager 698
affiliate or PSAO may not penalize or retaliate against a 699
pharmacist, pharmacy or pharmacy employee for exercising rights 700
under this chapter, initiating a judicial or regulatory action or 701
discussing or disclosing information pertaining to an agreement 702
with a pharmacy benefit manager or a pharmacy benefit manager 703
affiliate when testifying or otherwise appearing before a 704
governmental agency, legislative member or body, or a judicial 705
authority. 706
SECTION 12. Section 73-21-163, Mississippi Code of 1972, is 707
amended as follows: 708
73-21-163. (1) Whenever the * * * commissioner has reason 709
to believe that a pharmacy benefit manager * * *, pharmacy benefit 710
manager affiliate or PSAO is using, has used, or is about to use 711
any method, act or practice prohibited in * * * this act and that 712
proceedings would be in the public interest, it may bring an 713
action in the name of the * * * commissioner against the pharmacy 714
benefit manager * * *, pharmacy benefit manager affiliate or PSAO 715
to restrain by temporary or permanent injunction the use of such 716
method, act or practice. The action shall be brought in the 717
Chancery Court of the First Judicial District of Hinds County, 718
Mississippi. The court is authorized to issue temporary or 719
permanent injunctions to restrain and prevent violations of * * * 720
this act, and such injunctions shall be issued without bond. 721
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(2) The * * * commissioner may impose a monetary penalty on 722
a pharmacy benefit manager * * *, pharmacy benefit manager 723
affiliate or PSAO for noncompliance with the provisions of * * * 724
this act, in amounts of not less than One Thousand Dollars 725
($1,000.00) per violation and not more than Twenty-five Thousand 726
Dollars ($25,000.00) per violation. Each day a violation 727
continues for the same brand or generic product identifier or 728
brand or generic code number is a separate violation. Each day 729
that a pharmacy benefit manager or PSAO does business in this 730
state without a license is deemed a separate violation. The * * * 731
commissioner shall prepare a record entered upon its minutes that 732
states the basic facts upon which the monetary penalty was imposed 733
and reduce its decision to writing. Each instance that a pharmacy 734
benefit manager or PSAO fails to comply with the written order of 735
the commissioner is a separate violation of this act. Any penalty 736
collected under this subsection (2) shall be deposited into the 737
special fund * * * created under Section 73-21-157.1. 738
(3) For the purposes of conducting investigations, the 739
commissioner may conduct audits and examinations of a pharmacy 740
benefit manager or PSAO and also may issue subpoenas to any 741
individual, pharmacy, pharmacy benefit manager, PSAO or other 742
entity having documents or records that it deems relevant to the 743
investigation. 744
(4) The * * * commissioner may assess a monetary penalty for 745
those reasonable costs that are expended by the * * * Department 746
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of Insurance in the investigation and conduct of a proceeding, 747
including cost of process service, court reports, expert witnesses 748
and investigators, if the * * * commissioner imposes a monetary 749
penalty under subsection (2) of this section. 750
(5) * * * Monetary * * * penalties and costs assessed and 751
levied under this section shall be paid to the * * * commissioner 752
by the licensee, registrant or permit holder upon the expiration 753
of the period allowed for appeal of those penalties under Section 754
73-21-101, or may be paid sooner if the licensee, registrant or 755
permit holder elects. Any penalty collected by the * * * 756
commissioner under this subsection ( * * *5) shall be deposited 757
into the special fund * * * created under Section 73-21-157.1. 758
( * * *6) When payment of a monetary penalty assessed and 759
levied by the * * * commissioner against a licensee, registrant or 760
permit holder in accordance with this section is not paid by the 761
licensee, registrant or permit holder when due under this section, 762
the * * * commissioner shall have the power to institute and 763
maintain proceedings in its name for enforcement of payment in the 764
chancery court of the county and judicial district of residence of 765
the licensee, registrant or permit holder, or if the licensee, 766
registrant or permit holder is a nonresident of the State of 767
Mississippi, in the Chancery Court of the First Judicial District 768
of Hinds County, Mississippi. When those proceedings are 769
instituted, the * * * commissioner shall certify the record of its 770
proceedings, together with all documents and evidence, to the 771
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chancery court, and the matter shall be heard in due course by the 772
court, which shall review the record and make its determination 773
thereon in accordance with the provisions of Section 73-21-101. 774
The hearing on the matter may, in the discretion of the 775
chancellor, be tried in vacation. 776
(7) (a) The commissioner may conduct audits to ensure 777
compliance with the provisions of this act. In conducting audits, 778
the commissioner may request production of documents pertaining to 779
compliance with the provisions of this act, and documents so 780
requested must be produced within thirty (30) days of the request 781
unless extended by the commissioner or authorized staff of the 782
Department of Insurance. 783
(b) If, after the conclusion of the audit, the pharmacy 784
benefit manager or PSAO is found to be in compliance with all of 785
the requirements of this act, then the commissioner must pay the 786
costs of the audit. However, the pharmacy benefit manager or PSAO 787
being audited shall pay all costs of the audit if the audit 788
reveals noncompliance with this act. The cost of the audit 789
examination must be deposited into the special fund created under 790
Section 73-21-157.1. 791
(c) The commissioner may hire independent consultants 792
to conduct audits of a pharmacy benefit manager or PSAO and expend 793
funds collected under this section to pay the cost of performing 794
audit services. 795
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( * * *8) The * * * commissioner shall develop and implement 796
a uniform penalty policy that sets the minimum and maximum penalty 797
for any given violation of * * * this act. The * * * commissioner 798
shall adhere to its uniform penalty policy except in those cases 799
where the * * * commissioner specifically finds * * * that a 800
penalty in excess of, or less than, the uniform penalty is 801
appropriate. * * * 802
SECTION 13. The following shall be codified as Section 803
73-21-165, Mississippi Code of 1972: 804
73-21-165. (1) Each drug manufacturer shall submit a report 805
to the commissioner no later than the fifteenth day of January, 806
April, July, and October with the current wholesale acquisition 807
cost information for the prescription drugs sold in or into the 808
state by that drug manufacturer; however, the first report due 809
under this subsection shall not be due until October 1, 2027. 810
(2) Not more than thirty (30) days after an increase in 811
wholesale acquisition cost of forty percent (40%) or greater over 812
the preceding five (5) calendar years or ten percent (10%) or 813
greater in the preceding twelve (12) months for a prescription 814
drug with a wholesale acquisition cost of Seventy Dollars ($70.00) 815
or more for a manufacturer-packaged drug container, a drug 816
manufacturer shall submit a report to the commissioner. The 817
report must contain the following information: 818
(a) Name of the drug; 819
(b) Whether the drug is a brand name or a generic; 820
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(c) The effective date of the change in wholesale 821
acquisition cost; 822
(d) Aggregate, company-level research and development 823
costs for the previous calendar year; 824
(e) Aggregate rebate amounts paid to each pharmacy 825
benefit manager or PSAO for the previous calendar year; 826
(f) The name of each of the drug manufacturer's drugs 827
approved by the United States Food and Drug Administration in the 828
previous five (5) calendar years; 829
(g) The name of each of the drug manufacturer's drugs 830
that lost patent exclusivity in the United States in the previous 831
five (5) calendar years; and 832
(h) A concise statement of rationale regarding the 833
factor or factors that caused the increase in the wholesale 834
acquisition cost, such as raw ingredient shortage or increase in 835
pharmacy benefit manager's or PSAO's rebates. 836
(3) The quality and types of information and data a drug 837
manufacturer submits to the commissioner pursuant to this section 838
must be the same as the quality and types of information and data 839
the drug manufacturer includes in the drug manufacturer's annual 840
consolidated report on the Securities and Exchange Commission Form 841
10-K or any other public disclosure. A drug manufacturer shall 842
notify the commissioner in writing if the drug manufacturer is 843
introducing a new prescription drug to market at a wholesale 844
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acquisition cost that exceeds the threshold set for a specialty 845
drug under the Medicare Part D Program. 846
(4) The notice must include a concise statement of rationale 847
regarding the factor or factors that caused the new drug to exceed 848
the Medicare Part D Program price. The drug manufacturer shall 849
provide the written notice within three (3) calendar days 850
following the release of the drug in the commercial market. A 851
drug manufacturer may make the notification pending approval by 852
the United States Food and Drug Administration if commercial 853
availability is expected within three (3) calendar days following 854
the approval. 855
(5) On or before October 1st of each year, a pharmacy 856
benefit manager or PSAO providing services for a health care plan 857
shall file a report with the commissioner. The report must 858
contain the following information for the previous state fiscal 859
year: 860
(a) The aggregated rebates, fees, price protection 861
payments and any other payments collected from each drug 862
manufacturer; 863
(b) The aggregated dollar amount of rebates, price 864
protection payments, fees, and any other payments collected from 865
each drug manufacturer which were passed to health insurers; 866
(c) The aggregated fees, price concessions, penalties, 867
effective rates, and any other financial incentive collected from 868
pharmacies which were passed to enrollees at the point of sale; 869
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(d) The aggregated dollar amount of rebates, price 870
protection payments, fees, and any other payments collected from 871
drug manufacturers which were retained as revenue by the pharmacy 872
benefit manager or PSAO; and 873
(e) The aggregated rebates passed on to employers. 874
(6) Reports submitted by pharmacy benefit managers and PSAOs 875
under this section may not disclose the identity of a specific 876
health benefit plan or enrollee, the identity of a drug 877
manufacturer, the prices charged for specific drugs or classes of 878
drugs, or the amount of any rebates or fees provided for specific 879
drugs or classes of drugs. 880
(7) On or before October 1st of each year, each health 881
insurer shall submit a report to the commissioner. The report 882
must contain the following information for the previous two (2) 883
calendar years: 884
(a) Names of the twenty-five (25) most frequently 885
prescribed drugs across all plans; 886
(b) Names of the twenty-five (25) prescription drugs 887
dispensed with the highest dollar spent in terms of gross revenue; 888
(c) Percent of increase in annual net spending for 889
prescription drugs across all plans; 890
(d) Percent of increase in premiums which is 891
attributable to prescription drugs across all plans; 892
(e) Percentage of specialty drugs with utilization 893
management requirements across all plans; and 894
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(f) Premium reductions attributable to specialty drug 895
utilization management. 896
(8) A report submitted by a health insurer may not disclose 897
the identity of a specific health benefit plan or the prices 898
charged for specific prescription drugs or classes of prescription 899
drugs. 900
SECTION 14. The following shall be codified as Section 901
73-21-167, Mississippi Code of 1972: 902
73-21-167. Each plan sponsor shall develop a list of 903
prescription drugs that meet the criteria established by that plan 904
sponsor for specialty drug designation to assist with patient 905
access, transparency and responsible cost management for the 906
delivery of prescription drugs or services, or both. As an 907
alternative to developing its own list, a plan sponsor may elect 908
to adopt the specialty drug list developed by the State and School 909
Employees Health Insurance Management Board under Section 910
25-15-305 to serve as its specialty drug list. 911
SECTION 15. The following shall be codified as Section 912
73-21-168, Mississippi Code of 1972: 913
73-21-168. (1) The commissioner shall develop a website to 914
publish information the commissioner receives under this chapter. 915
The commissioner shall make the website available on the 916
Department of Insurance website with a dedicated link prominently 917
displayed on the home page, or by a separate, easily identifiable 918
Internet address. 919
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(2) Within sixty (60) days of receipt of reported 920
information under this chapter, the commissioner shall publish the 921
reported information on the website developed under this section. 922
The information the commissioner publishes may not disclose or 923
tend to disclose trade secrets, proprietary, commercial, financial 924
or confidential information of any pharmacy, pharmacy benefit 925
manager, PSAO, drug wholesaler, drug manufacturer or hospital. 926
(3) The commissioner may adopt rules to implement this 927
chapter. The commissioner shall develop forms that must be used 928
for reporting required under this chapter. The commissioner may 929
contract for services to implement this chapter. 930
(4) A report received by the commissioner is not subject to 931
the provisions of the federal Freedom of Information Act or the 932
Mississippi Public Records Act and may not be released by the 933
commissioner unless subject to an order from a court of competent 934
jurisdiction. The commissioner shall destroy or delete or cause 935
to be destroyed or deleted all such information thirty (30) days 936
after the commissioner determines that the information is no 937
longer necessary or useful. 938
SECTION 16. The following shall be codified as Section 939
73-21-169, Mississippi Code of 1972: 940
73-21-169. (1) Pharmacy benefit managers and PSAOs shall 941
identify to the commissioner any ownership affiliation of any kind 942
with any pharmacy which, either directly or indirectly, through 943
one or more intermediaries: 944
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(a) Has an investment or ownership interest in a 945
pharmacy benefit manager or PSAO holding a certificate of 946
authority; 947
(b) Shares common ownership with a pharmacy benefit 948
manager or PSAO holding a certificate of authority in this state; 949
or 950
(c) Has an investor or a holder of an ownership 951
interest which is a pharmacy benefit manager or PSAO holding a 952
certificate of authority issued in this state. 953
(2) A pharmacy benefit manager or PSAO shall report any 954
change in information required by this act to the commissioner in 955
writing within sixty (60) days after the change occurs. 956
SECTION 17. Section 73-21-83, Mississippi Code of 1972, is 957
amended as follows: 958
73-21-83. (1) The board shall be responsible for the 959
control and regulation of the practice of pharmacy, to include the 960
regulation of pharmacists, pharmacy externs or interns and 961
pharmacist technicians, in this state, the regulation of the 962
manufacturing and distribution of drugs and devices as defined in 963
Section 73-21-73, and the distribution of sample drugs or devices 964
by manufacturer's distributors as defined in Section 73-21-73 by 965
persons other than the original manufacturer or distributor in 966
this state * * *. 967
(2) A license for the practice of pharmacy shall be obtained 968
by all persons prior to their engaging in the practice of 969
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pharmacy. However, the provisions of this chapter shall not apply 970
to practitioners who are licensed under the laws of the State of 971
Mississippi and are authorized to dispense and administer 972
prescription drugs in the course of their professional practice. 973
(3) The initial licensure fee shall be set by the board but 974
shall not exceed Two Hundred Dollars ($200.00) * * *. 975
(4) All students actively enrolled in a professional school 976
of pharmacy accredited by the Accreditation Council for Pharmacy 977
Education who are making satisfactory progress toward graduation 978
and who act as an extern or intern under the direct supervision of 979
a pharmacist in a location permitted by the Board of Pharmacy must 980
obtain a pharmacy student registration prior to engaging in such 981
activity. The student registration fee shall be set by the board 982
but shall not exceed One Hundred Dollars ($100.00). 983
(5) All persons licensed to practice pharmacy prior to July 984
1, 1991, by the State Board of Pharmacy under Section 73-21-89 985
shall continue to be licensed under the provisions of Section 986
73-21-91. 987
SECTION 18. Section 73-21-91, Mississippi Code of 1972, is 988
amended as follows: 989
73-21-91. (1) Every pharmacist shall renew his license 990
annually. To renew his license, a pharmacist shall: 991
(a) Submit an application for renewal on the form 992
prescribed by the board; 993
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(b) Submit satisfactory evidence of the completion of 994
such continuing education units as shall be required by the board, 995
but in no case less than one (1) continuing education unit in the 996
last licensure period; 997
(c) * * * Pay any renewal fees as required by the 998
board, not to exceed One Hundred Dollars ($100.00) for each annual 999
licensing period, provided that the board may add a surcharge of 1000
not more than Ten Dollars ($10.00) to a license renewal fee to 1001
fund a program to aid impaired pharmacists or pharmacy students. 1002
Any pharmacist license renewal received postmarked after December 1003
31 of the renewal period will be returned and a Fifty Dollar 1004
($50.00) late renewal fee will be assessed before renewal. 1005
* * * 1006
(2) Any pharmacist who has defaulted in license renewal may 1007
be reinstated within two (2) years upon payment of renewal fees in 1008
arrears and presentation of evidence of the required continuing 1009
education. Any pharmacist defaulting in license renewal for a 1010
period in excess of two (2) years shall be required to 1011
successfully complete the examination approved by the board 1012
pursuant to Section 73-21-85 before being eligible for 1013
reinstatement as a pharmacist in Mississippi, or shall be required 1014
to appear before the board to be examined for his competence and 1015
knowledge of the practice of pharmacy, and may be required to 1016
submit evidence of continuing education. If the person is found 1017
fit by the board to practice pharmacy in this state, the board may 1018
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reinstate his license to practice pharmacy upon payment of all 1019
renewal fees in arrears. 1020
(3) Each application or filing made under this section shall 1021
include the social security number(s) of the applicant in 1022
accordance with Section 93-11-64. 1023
SECTION 19. Section 25-15-301, Mississippi Code of 1972, is 1024
amended as follows: 1025
25-15-301. (1) The board * * * shall contract the 1026
administration and service of the self-insured program to a third 1027
party. * * * When contracting with an administrator for the 1028
insurance plan established by Section 25-15-3 et seq. or 1029
components of the plan, * * * the board shall comply with the 1030
procedures set forth in this section: 1031
(a) * * * Before entering into a contract for the 1032
administration of the plan or components of the plan to an 1033
administrator, it shall cause to be prepared a request for 1034
proposals every two (2) years. This request for proposals shall 1035
be prepared for distribution to any interested party. Notice of 1036
the board's intention to seek proposals shall be published in a 1037
newspaper of general circulation at least one (1) time per week 1038
for three (3) weeks before closing the period for interested 1039
parties to respond. Additional forms of notice may also be used. 1040
The newspaper notice shall inform the interested parties of the 1041
service to be contracted, existence of a request for proposals, 1042
how it can be obtained, when a proposal must be submitted, and to 1043
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whom the proposal must be submitted. All requests for proposals 1044
shall describe clearly what service is to be contracted, and shall 1045
fully explain the criteria upon which an evaluation of proposals 1046
shall be based. The criteria to be used for evaluations shall, at 1047
minimum, include: 1048
(i) The administrator's proven ability to 1049
handle * * * group accident and health insurance plans comparable 1050
to the plan; 1051
(ii) The efficiency of the claims-paying 1052
procedures; and 1053
(iii) * * * The total charges for administering 1054
the plan. 1055
(b) All proposals submitted by interested parties shall 1056
be evaluated by an internal review committee which shall apply the 1057
same criteria to all proposals when conducting an evaluation. The 1058
committee shall consist of at least three (3) members of the 1059
board. When the proposal under evaluation is for pharmacy 1060
benefits or the management thereof, the Commissioner of Insurance, 1061
or his or her designee, shall be one (1) of the members of the 1062
evaluation committee. The results and recommendations of the 1063
evaluation shall be presented to the board for review. All 1064
evaluations presented to the board shall be retained by the board 1065
for at least three (3) years. The board may accept or reject any 1066
recommendation of the review committee, or it may conduct further 1067
inquiry into the proposals. Any further inquiry shall be clearly 1068
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documented and all methods and recommendations shall be retained 1069
by the board and shall spread upon its minutes its choice of 1070
administrator and its reasons for making the choice. 1071
(c) (i) The board shall be responsible for preparing a 1072
contract that shall be in accordance with all provisions of this 1073
section and all other provisions of law. The contract shall also 1074
include a requirement that the contractor shall consent to an 1075
evaluation of his performance. Such evaluation shall occur after 1076
the first six (6) months of the contract, and the contractor's 1077
performance shall be reviewed at times the board determines to be 1078
necessary. The contract shall clearly describe the standards upon 1079
which the contractor shall be evaluated. Evaluations shall 1080
include, but not be limited to, efficiency in claims processing, 1081
including the processing pending claims. 1082
(ii) The PEER Committee, at the request of the 1083
House or Senate Appropriations Committee or the House or Senate 1084
Insurance Committee and with funds specifically appropriated by 1085
the Legislature for such purpose, shall contract with an 1086
accounting firm or with other professionals to conduct a 1087
compliance audit of any administrator responsible for 1088
administering the insurance plan established by Section 25-15-3 et 1089
seq. or components of the plan. Such audit shall review the 1090
administrator's compliance with the performance standards required 1091
for inclusion in the administrator's contract. Such audit shall 1092
be delivered to the Legislature no later than January 1. 1093
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(iii) An audit for pharmacy benefits or the 1094
management of pharmacy benefits also may be conducted by the 1095
Commissioner of Insurance. Any audit conducted by the 1096
commissioner must be provided to the board and the PEER Committee 1097
within fifteen (15) days of final adoption by the commissioner. 1098
(2) Contracts for the administration of the insurance plan 1099
established in Section 25-15-3 et seq. or components of the plan 1100
shall be for a term of two (2) years and shall commence at the 1101
beginning of the calendar year and shall end on the last day 1102
of * * * the next succeeding calendar year. This shall not apply 1103
to contracts provided for in subsection (3) of this section. 1104
(3) If the board determines that it is necessary * * * to 1105
terminate a contract with or without cause as provided for in the 1106
contract of the administrator, the board is authorized to select 1107
an administrator without complying with the bid requirements in 1108
subsections (1) and (2) of this section. Such contracts shall be 1109
for the balance of the calendar year in which the * * * 1110
termination occurred * * *. Any contract negotiated on an interim 1111
basis shall include a detailed transition plan which shall ensure 1112
the orderly transfer of responsibilities between administrators 1113
and shall include, but not be limited to, provisions regarding the 1114
transfer of records, files and tapes. 1115
(4) Except for contracts executed under the authority of 1116
subsection (3) of this section, the board shall select 1117
administrators at least six (6) months before the expiration of 1118
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the current administrator's contract. The period between the 1119
selection of the new administrator and the effective date of the 1120
new contract shall be known as the transition period. Whenever 1121
the newly selected administrator is an entity different from the 1122
entity performing the administrator's function, it shall be the 1123
duty of the board to prepare a detailed transition plan which 1124
shall insure the orderly transfer of responsibilities between 1125
administrators. This plan shall be effective during the 1126
transition period, and shall include, but not be limited to, 1127
provisions regarding the transfer of records, files and tapes. 1128
Further, the plan shall detail the steps necessary to transfer 1129
records and responsibilities and set deadlines for when such steps 1130
should be completed. The board shall include in all requests for 1131
proposals, contracts with administrators, and all other contracts, 1132
provisions requiring the cooperation of administrators and 1133
contractors in any future transition of responsibilities, and 1134
their cooperation with the board and other contractors with 1135
respect to ongoing coordination and delivery of health plan 1136
services. The board shall furnish the Legislature, Governor and 1137
advisory council with copies of all transition plans and keep them 1138
informed of progress on such plans. 1139
(5) No brokerage fees shall be paid for the securing or 1140
executing of any contracts pertaining to the insurance plan 1141
established by Section 25-15-3 et seq. or components of the plan, 1142
whether fully insured or self-insured. 1143
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(6) (a) Any corporation, association, company, entity or 1144
individual that contracts with the board for the administration or 1145
service of the self-insured plan shall remit one hundred percent 1146
(100%) of all savings or discounts resulting from any contract to 1147
the board or participant, or both. Any corporation, association, 1148
company, entity or individual that contracts with the board for 1149
the administration or service of the self-insured plan shall 1150
allow, upon notice by the board, the board or its designee to 1151
audit records of the corporation, association, company, entity or 1152
individual relative to the corporation, association, company, 1153
entity or individual's performance under any contract with the 1154
board. The information maintained by any corporation, 1155
association, company, entity or individual, relating to such 1156
contracts, shall be available for inspection upon request by the 1157
board and such information shall be compiled in a manner that will 1158
provide a clear audit trail. 1159
(b) A corporation, association, company, entity or 1160
individual that contracts with the board for the administration or 1161
service of the pharmacy benefits or management of pharmacy 1162
benefits of the self-insured plan shall comply with the provisions 1163
of Chapter 21, Title 73, Mississippi Code of 1972. If there is a 1164
conflict in the application or interpretation of these provisions, 1165
then the provision of Chapter 21, Title 73, Mississippi Code of 1166
1972, will prevail. 1167
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SECTION 20. Section 25-15-303, Mississippi Code of 1972, is 1168
amended as follows: 1169
25-15-303. (1) There is created the State and School 1170
Employees Health Insurance Management Board, which shall 1171
administer the State and School Employees Life and Health 1172
Insurance Plan provided for under Section 25-15-3 et seq. The 1173
State and School Employees Health Insurance Management Board, 1174
hereafter referred to as the "board," shall also be responsible 1175
for administering all procedures for selecting third-party 1176
administrators provided for in Section 25-15-301. 1177
(2) The board shall consist of the following: 1178
(a) The Chairman of the Workers' Compensation 1179
Commission or his or her designee; 1180
(b) The State Personnel Director, or his or her 1181
designee; 1182
(c) The Commissioner of Insurance, or his or her 1183
designee; 1184
(d) The * * * Executive Director of the Division of 1185
Medicaid, or his or her designee; 1186
* * * 1187
( * * *e) The Executive Director of the Department of 1188
Finance and Administration, or his or her designee; 1189
* * * 1190
( * * *f) The Executive Director of the Public 1191
Employees' Retirement System, or his or her designee; 1192
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(g) The Executive Director of the State Board of 1193
Pharmacy, or his or her designee; 1194
( * * *h) Two (2) appointees of the Governor whose 1195
terms shall be concurrent with that of the Governor, one (1) of 1196
whom shall have experience in providing actuarial advice to 1197
companies that provide health insurance to large groups and one 1198
(1) of whom shall have experience in the day-to-day management and 1199
administration of a large self-funded health insurance group; 1200
( * * *i) * * * A representative of the Mississippi 1201
Association of Health Plans; 1202
( * * *j) * * * An independent pharmacist, appointed by 1203
the Mississippi Independent Pharmacies Association; 1204
(k) A pharmacy benefit manager licensed to do business 1205
in Mississippi, appointed by the Mississippi Association of 1206
Self-Insurers; 1207
(l) A plan sponsor, as defined in Section 73-21-153, or 1208
a third party administrator doing business in Mississippi, 1209
appointed by the Mississippi Association of Self-Insurers; 1210
( * * *m) The Chairman of the Senate Appropriations 1211
Committee, or his or her designee; and 1212
( * * *n) The Chairman of the House of Representatives 1213
Appropriations Committee, or his or her designee. 1214
The legislators, or their designees, shall serve as ex 1215
officio, nonvoting members of the board. 1216
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The Executive Director of the Department of Finance and 1217
Administration shall be the chairman of the board. 1218
(3) The board shall meet at least monthly and maintain 1219
minutes of the meetings. A quorum shall consist of a majority of 1220
the authorized voting membership of the board. The board shall 1221
have the sole authority to promulgate rules and regulations 1222
governing the operations of the insurance plans and shall be 1223
vested with all legal authority necessary and proper to perform 1224
this function including, but not limited to: 1225
(a) Defining the scope and coverages provided by the 1226
insurance plan; 1227
(b) Seeking proposals for services or insurance through 1228
competitive processes where required by law and selecting service 1229
providers or insurers under procedures provided for by law; and 1230
(c) Developing and adopting strategic plans and budgets 1231
for the insurance plan. 1232
The department shall employ a State Insurance Administrator, 1233
who shall be responsible for the day-to-day management and 1234
administration of the insurance plan. The Department of Finance 1235
and Administration shall provide to the board on a full-time basis 1236
personnel and technical support necessary and sufficient to 1237
effectively and efficiently carry out the requirements of this 1238
section. 1239
(4) Members of the board shall not receive any compensation 1240
or per diem, but may receive travel reimbursement provided for 1241
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under Section 25-3-41 except that the legislators shall receive 1242
per diem and expenses, which shall be paid from the contingent 1243
expense funds of their respective houses in the same amounts as 1244
provided for committee meetings when the Legislature is not in 1245
session; however, no per diem and expenses for attending meetings 1246
of the board shall be paid while the Legislature is in session. 1247
SECTION 21. The following shall be codified as Section 1248
25-15-305, Mississippi Code of 1972: 1249
25-15-305. (1) The State and School Employees Health 1250
Insurance Management Board shall develop a list of prescription 1251
drugs that meet the criteria established by the board for 1252
specialty drug designation to assist with patient access, 1253
transparency and responsible cost management. The board shall 1254
meet to review and update the specialty drug list based on market 1255
trends, clinical data and stakeholder input. 1256
(2) A contract entered into pursuant to Section 25-15-301 1257
for the administration of the plan or for the provision or 1258
administration of pharmacy benefit management services, as defined 1259
under Section 73-21-153, must include a provision requiring the 1260
corporation, association, company, entity or individual that is a 1261
party to the contract to adhere to the established list of 1262
specialty drugs when contracting with a pharmacy and establishing 1263
payment levels and adjudicating drug claims or any portion of the 1264
transaction. Noncompliance with this subsection or the failure to 1265
adhere to the established list of specialty drugs is deemed to be 1266
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a violation of this section and may be deemed by the board as 1267
cause for termination of the contract. 1268
(3) The board shall consult with the state agency or entity 1269
in the four (4) states contiguous to Mississippi to determine the 1270
feasibility of entering into a joint agreement that enables the 1271
parties to the agreement to achieve greater purchasing power of 1272
pharmaceuticals in the states that are a party to the agreement. 1273
Before March 1, 2027, the board shall submit a detailed report of 1274
its findings and recommendations to the State Affairs Committee of 1275
the House of Representatives and the Insurance Committee of the 1276
Senate. 1277
SECTION 22. Section 25-15-11, Mississippi Code of 1972, is 1278
amended as follows: 1279
25-15-11. (1) The board is authorized to execute a contract 1280
or contracts to provide the benefits under the plan. Such 1281
contract or contracts may be executed with one or more 1282
corporations or associations licensed to transact life and 1283
accident and health insurance business in this state; however, no 1284
such contract shall be executed with any corporation, association 1285
or company domiciled in any other state except that such 1286
corporation, association or company shall meet the conditions and 1287
terms for a like contract established by the state of the domicile 1288
of such corporation, association or company for a Mississippi 1289
corporation, association or company. No corporation, association 1290
or company with less than five (5) years' experience in the life 1291
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and health field may bid. All of the benefits to be provided 1292
under the plan may be included in one or more similar contracts, 1293
or the benefits may be classified into different types with each 1294
type included under one or more similar contracts issued by the 1295
same or different companies. 1296
The board shall supply the statistical information upon which 1297
a quotation is to be calculated, upon request, to all carriers 1298
licensed in the state. Bids may be accepted at the discretion of 1299
the board, and the board shall have the right to adjust rates on 1300
an annual basis if the board shall deem such adjustment necessary. 1301
The plan for active employees shall be on retention accounting 1302
basis, and a separate retention accounting basis shall be used for 1303
retired employees. Any additional written information the carrier 1304
wishes to submit, supporting the proposed benefits and premium 1305
rate, may accompany the proposal. After receiving the proposals, 1306
the board shall determine whether to contract with the carrier 1307
which has been determined to have submitted the lowest and best 1308
bid, or to reject all such bids and receive new proposals. 1309
The board shall authorize any corporation licensed to 1310
transact accident and health insurance business in this state 1311
issuing any such contract to reinsure portions of such contract 1312
with any other such corporation which elected to be a reinsurer 1313
and is legally competent to enter into a reinsurance agreement. 1314
The board may designate one or more of such corporations as the 1315
administering corporation or corporations. Each employee who is 1316
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covered under any such contract or contracts shall receive a 1317
certificate setting forth the benefits to which the employee is 1318
entitled thereunder, to whom such benefits shall be payable, to 1319
whom claims should be submitted, and summarizing the provisions of 1320
the contract principally affecting the employee. Such certificate 1321
shall be in lieu of the certificate which the corporation or 1322
corporations issuing such contract or contracts would otherwise 1323
issue. 1324
The board may reject any and all bids and contracts under 1325
this section and may elect for the state to become a self-insurer; 1326
however, administration and service of any such self-insured 1327
program * * * must be contracted to a third party by the board. 1328
Any contract with a third party to administer the plan shall 1329
be bid and entered into in accordance with the procedures provided 1330
in Section 25-15-301. 1331
(2) By September 30 of each year, the board shall report to 1332
the Joint Legislative Budget Committee, Senate Insurance 1333
Committee, House Insurance Committee, Senate Education Committee, 1334
House Education Committee and Joint Legislative Committee on 1335
Performance Evaluation and Expenditure Review the condition of the 1336
State and School Employees Life and Health Insurance Plan. Such 1337
report shall contain for the most recently completed fiscal year, 1338
but not be limited to, the following: 1339
(a) The plan's financial condition at the close of the 1340
fiscal year. 1341
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(b) The history of yearly claims paid and premiums 1342
received for each premium class, including, but not limited to, 1343
active employees, dependents and retirees. 1344
(c) The history of loss ratios for the active 1345
employees, dependents and retirees premium classes as well as 1346
historical trend of such ratios. For the purposes of this 1347
section, the term "loss ratios" means claims paid by the plan for 1348
each premium class divided by premiums received by the plan for 1349
insurance coverage of the members in that premium class. 1350
(d) Budgetary information, including: 1351
(i) A detailed breakdown of all expenditures of 1352
the plan, administrative and otherwise, for the most recently 1353
completed fiscal year and projected expenditures, administrative 1354
and otherwise, for the current and next fiscal year; 1355
(ii) A schedule of all contracts, administrative 1356
and otherwise, executed for the benefit of the plan during the 1357
most recent completed fiscal year and those executed and 1358
anticipated for the current fiscal year; and 1359
(iii) A description of the processes used by the 1360
board to procure all contracts, administrative and otherwise, as 1361
well as a description of the scope of services to be provided by 1362
each contractor. 1363
Budgetary information shall be provided in a format 1364
designated by the Joint Legislative Budget Committee. 1365
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The Joint Legislative Budget Committee, Senate Insurance 1366
Committee, House Insurance Committee * * * and Joint Legislative 1367
Committee on Performance Evaluation and Expenditure Review may 1368
request additional information or reports from the board on an 1369
as-needed basis. 1370
(3) Annually, the board shall request, and the Department of 1371
Audit shall conduct, a comprehensive audit of the State and School 1372
Employees Life and Health Insurance Plan. For purposes of this 1373
section, the audit required herein shall be separate and distinct 1374
from any audit prepared in conjunction with the development of the 1375
Comprehensive Annual Financial Report (CAFR). 1376
SECTION 23. Section 25-15-3, Mississippi Code of 1972, is 1377
brought forward as follows: 1378
25-15-3. For the purposes of this article, the words and 1379
phrases used herein shall have the following meanings: 1380
(a) "Employee" means a person who works full time for 1381
the State of Mississippi and receives his compensation in a direct 1382
payment from a department, agency or institution of the state 1383
government and any person who works full time for any school 1384
district, community/junior college, public library or 1385
university-based program authorized under Section 37-23-31 for 1386
deaf, aphasic and emotionally disturbed children or any regular 1387
nonstudent bus driver. This shall include legislators, employees 1388
of the legislative branch and the judicial branch of the state and 1389
"employees" shall include full-time salaried judges and full-time 1390
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district attorneys and their staff and full-time compulsory school 1391
attendance officers. For the purposes of this article, any 1392
"employee" making contributions to the State of Mississippi 1393
retirement plan shall be considered a full-time employee. For 1394
purposes of this article, "employee" shall not mean contract 1395
personnel. 1396
(b) "Department" means the Department of Finance and 1397
Administration. 1398
(c) "Plan" means the State and School Employees Life 1399
and Health Insurance Plan created under this article. 1400
(d) "Fund" means the State and School Employees 1401
Insurance Fund set up under this article. 1402
(e) "Retiree" means any employee retired under the 1403
Mississippi retirement plan. 1404
(f) "Board" means the State and School Employees Health 1405
Insurance Management Board created under Section 25-15-303. 1406
SECTION 24. Section 25-15-5, Mississippi Code of 1972, is 1407
brought forward as follows: 1408
25-15-5. (1) The board shall administer the plan and is 1409
authorized to adopt and promulgate rules and regulations for its 1410
administration, subject to the terms and limitations contained in 1411
this article. 1412
(2) The board shall develop a five-year strategic plan for 1413
the insurance plan established by Section 25-15-3 et seq. The 1414
strategic plan shall address, but not be limited to: 1415
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(a) Changing trends in the health care industry, and 1416
how they effect delivery of services to members of the plan. 1417
(b) Alternative service delivery systems. 1418
(c) Any foreseeable problems with the present system of 1419
delivering and administering health care benefits in Mississippi. 1420
(d) The development of options and recommendations for 1421
changes in the plan. 1422
(3) To carry out the requirements of subsection (2) of this 1423
section, the board may conduct formal research, including 1424
questionnaires and attitudinal surveys of members' needs and 1425
preferences with respect to service delivery. 1426
(4) After the board has complied with all provisions of 1427
Section 25-15-9 regarding the establishment of the plan, it shall 1428
be responsible for fully disclosing to plan members the provisions 1429
of the plan. Such disclosure shall consist of the dissemination 1430
of educational material on the plan and any proposed changes 1431
thereto. The board shall provide members with complete 1432
educational materials at least thirty (30) days before the date 1433
upon which the plan's members must select a plan option for health 1434
care services. The board shall further use the resources of the 1435
Mississippi Authority for Educational Television or other state 1436
agency, university or college to provide information on proposed 1437
changes. The board may also use other state-owned media, as well 1438
as public service announcements on private media to disseminate 1439
information regarding proposed changes in the plan. 1440
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(5) The board shall develop and make available for public 1441
review at its offices a comprehensive plan document which 1442
documents all benefits for which members of the plan created by 1443
Section 25-15-3 et seq. are eligible. This document shall be 1444
typed and maintained also at the offices of any administrator 1445
contracted with in accordance with Section 25-15-301. 1446
(6) (a) The board may enter into contracts with 1447
accountants, actuaries and other persons from the private sector 1448
whose skills are necessary to carry out the purposes of Section 1449
25-15-3 et seq. 1450
(b) Before the board enters into any contract for 1451
services as provided in paragraph (a) of this subsection, the 1452
board shall first determine that the services are required, and 1453
that the staff of the board and personnel of other state agencies 1454
are not sufficiently experienced to provide the services. 1455
(c) If the service is to be rendered for a period of in 1456
excess of six (6) months, the board shall seek and obtain bids for 1457
the service in a manner identical to that provided for in Section 1458
25-15-301, subsection (1)(a) and (b) except for those provisions 1459
which specifically state criteria which are applicable only to 1460
third-party administrators contracted with in accordance with 1461
Section 25-15-3 et seq. 1462
(d) The board is also authorized to procure legal 1463
services if it deems these services to be necessary to carry out 1464
its responsibilities under Section 25-15-3 et seq. 1465
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SECTION 25. Section 25-15-7, Mississippi Code of 1972, is 1466
brought forward as follows: 1467
25-15-7. Such health insurance shall not include expense 1468
incurred by or on account of an individual prior to July 1, 1972, 1469
as to him; dental care and treatment, except dental surgery and 1470
appliances to the extent necessary for the correction of damage 1471
caused by accidental injury while covered by the plan, or as a 1472
direct result of disease covered by the plan; eyeglasses, hearing 1473
aids for individuals over the age of twenty-one (21) years, and 1474
examinations for the prescription or fitting thereof; cosmetic 1475
surgery or treatment, except to the extent necessary for 1476
correction of damage by accidental injury while covered by the 1477
plan or as a direct result of disease covered by the plan; 1478
services received in a hospital owned or operated by the United 1479
States government for which no charge is made; services received 1480
for injury or sickness due to war or any act of war, whether 1481
declared or undeclared, which war or act of war shall have 1482
occurred after July 1, 1972; expense for which the individual is 1483
not required to make payment; expenses to the extent of benefits 1484
provided under any employer group plan other than this plan, in 1485
which the state participates in the cost thereof; and such other 1486
expenses as may be excluded by regulations of the board. 1487
SECTION 26. Section 25-15-9, Mississippi Code of 1972, is 1488
brought forward as follows: 1489
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25-15-9. (1) (a) The board shall design a plan of health 1490
insurance for state employees that provides benefits for 1491
semiprivate rooms in addition to other incidental coverages that 1492
the board deems necessary. The amount of the coverages shall be 1493
in such reasonable amount as may be determined by the board to be 1494
adequate, after due consideration of current health costs in 1495
Mississippi. The plan shall also include major medical benefits 1496
in such amounts as the board determines. The plan shall provide 1497
for coverage for telemedicine services as provided in Section 1498
83-9-351. The board is also authorized to accept bids for such 1499
alternate coverage and optional benefits as the board deems 1500
proper. The board is authorized to accept bids for surgical 1501
services that include assistance in locating a surgeon, setting up 1502
initial consultation, travel, a negotiated single case rate bundle 1503
and payment for orthopedic, spine, bariatric, cardiovascular and 1504
general surgeries. The surgical services may only utilize 1505
surgeons and facilities located in the State of Mississippi unless 1506
otherwise provided by the board. Any contract for alternative 1507
coverage and optional benefits shall be awarded by the board after 1508
it has carefully studied and evaluated the bids and selected the 1509
best and most cost-effective bid. The board may reject all of the 1510
bids; however, the board shall notify all bidders of the rejection 1511
and shall actively solicit new bids if all bids are rejected. The 1512
board may employ or contract for such consulting or actuarial 1513
services as may be necessary to formulate the plan, and to assist 1514
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the board in the preparation of specifications and in the process 1515
of advertising for the bids for the plan. Those contracts shall 1516
be solicited and entered into in accordance with Section 25-15-5. 1517
The board shall keep a record of all persons, agents and 1518
corporations who contract with or assist the board in preparing 1519
and developing the plan. The board in a timely manner shall 1520
provide copies of this record to the members of the advisory 1521
council created in this section and those legislators, or their 1522
designees, who may attend meetings of the advisory council. The 1523
board shall provide copies of this record in the solicitation of 1524
bids for the administration or servicing of the self-insured 1525
program. Each person, agent or corporation that, during the 1526
previous fiscal year, has assisted in the development of the plan 1527
or employed or compensated any person who assisted in the 1528
development of the plan, and that bids on the administration or 1529
servicing of the plan, shall submit to the board a statement 1530
accompanying the bid explaining in detail its participation with 1531
the development of the plan. This statement shall include the 1532
amount of compensation paid by the bidder to any such employee 1533
during the previous fiscal year. The board shall make all such 1534
information available to the members of the advisory council and 1535
those legislators, or their designees, who may attend meetings of 1536
the advisory council before any action is taken by the board on 1537
the bids submitted. The failure of any bidder to fully and 1538
accurately comply with this paragraph shall result in the 1539
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rejection of any bid submitted by that bidder or the cancellation 1540
of any contract executed when the failure is discovered after the 1541
acceptance of that bid. The board is authorized to promulgate 1542
rules and regulations to implement the provisions of this 1543
subsection. 1544
The board shall develop plans for the insurance plan 1545
authorized by this section in accordance with the provisions of 1546
Section 25-15-5. 1547
Any corporation, association, company or individual that 1548
contracts with the board for the third-party claims administration 1549
of the self-insured plan shall prepare and keep on file an 1550
explanation of benefits for each claim processed. The explanation 1551
of benefits shall contain such information relative to each 1552
processed claim that the board deems necessary, and, at a minimum, 1553
each explanation shall provide the claimant's name, claim number, 1554
provider number, provider name, service dates, type of services, 1555
amount of charges, amount allowed to the claimant and reason 1556
codes. The information contained in the explanation of benefits 1557
shall be available for inspection upon request by the board. The 1558
board shall have access to all claims information utilized in the 1559
issuance of payments to employees and providers. 1560
(b) There is created an advisory council to advise the 1561
board in the formulation of the State and School Employees Health 1562
Insurance Plan. The council shall be composed of the State 1563
Insurance Commissioner, or his designee, an 1564
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employee-representative of the institutions of higher learning 1565
appointed by the board of trustees thereof, an 1566
employee-representative of the Department of Transportation 1567
appointed by the director thereof, an employee-representative of 1568
the Department of Revenue appointed by the Commissioner of 1569
Revenue, an employee-representative of the Mississippi Department 1570
of Health appointed by the State Health Officer, an 1571
employee-representative of the Mississippi Department of 1572
Corrections appointed by the Commissioner of Corrections, and an 1573
employee-representative of the Department of Human Services 1574
appointed by the Executive Director of Human Services, two (2) 1575
certificated public school administrators appointed by the State 1576
Board of Education, two (2) certificated classroom teachers 1577
appointed by the State Board of Education, a noncertificated 1578
school employee appointed by the State Board of Education and a 1579
community/junior college employee appointed by the Mississippi 1580
Community College Board. 1581
The Lieutenant Governor may designate the Secretary of the 1582
Senate, the Chairman of the Senate Appropriations Committee, the 1583
Chairman of the Senate Education Committee and the Chairman of the 1584
Senate Insurance Committee, and the Speaker of the House of 1585
Representatives may designate the Clerk of the House, the Chairman 1586
of the House Appropriations Committee, the Chairman of the House 1587
Education Committee and the Chairman of the House Insurance 1588
Committee, to attend any meeting of the State and School Employees 1589
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Insurance Advisory Council. The appointing authorities may 1590
designate an alternate member from their respective houses to 1591
serve when the regular designee is unable to attend the meetings 1592
of the council. Those designees shall have no jurisdiction or 1593
vote on any matter within the jurisdiction of the council. For 1594
attending meetings of the council, the legislators shall receive 1595
per diem and expenses, which shall be paid from the contingent 1596
expense funds of their respective houses in the same amounts as 1597
provided for committee meetings when the Legislature is not in 1598
session; however, no per diem and expenses for attending meetings 1599
of the council will be paid while the Legislature is in session. 1600
No per diem and expenses will be paid except for attending 1601
meetings of the council without prior approval of the proper 1602
committee in their respective houses. 1603
(c) No change in the terms of the State and School 1604
Employees Health Insurance Plan may be made effective unless the 1605
board, or its designee, has provided notice to the State and 1606
School Employees Health Insurance Advisory Council and has called 1607
a meeting of the council at least fifteen (15) days before the 1608
effective date of the change. If the State and School Employees 1609
Health Insurance Advisory Council does not meet to advise the 1610
board on the proposed changes, the changes to the plan shall 1611
become effective at such time as the board has informed the 1612
council that the changes shall become effective. 1613
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(d) Medical benefits for retired employees and 1614
dependents under age sixty-five (65) years and not eligible for 1615
Medicare benefits. For employees who retire before July 1, 2005, 1616
and for employees retiring due to work-related disability under 1617
the Public Employees' Retirement System, the same health insurance 1618
coverage as for all other active employees and their dependents 1619
shall be available to retired employees and all dependents under 1620
age sixty-five (65) years who are not eligible for Medicare 1621
benefits, the level of benefits to be the same level as for all 1622
other active participants. For employees who retire on or after 1623
July 1, 2005, and not retiring due to work-related disability 1624
under the Public Employees' Retirement System, the same health 1625
insurance coverage as for all other active employees and their 1626
dependents shall be available to those retiring employees and all 1627
dependents under age sixty-five (65) years who are not eligible 1628
for Medicare benefits only if the retiring employees were 1629
participants in the State and School Employees Health Insurance 1630
Plan for four (4) years or more before their retirement, the level 1631
of benefits to be the same level as for all other active 1632
participants. This section will apply to those employees who 1633
retire due to one hundred percent (100%) medical disability as 1634
well as those employees electing early retirement. 1635
(e) Medical benefits for retired employees and 1636
dependents over age sixty-five (65) years or otherwise eligible 1637
for Medicare benefits. For employees who retire before July 1, 1638
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2005, and for employees retiring due to work-related disability 1639
under the Public Employees' Retirement System, the health 1640
insurance coverage available to retired employees over age 1641
sixty-five (65) years or otherwise eligible for Medicare benefits, 1642
and all dependents over age sixty-five (65) years or otherwise 1643
eligible for Medicare benefits, shall be the major medical 1644
coverage. For employees retiring on or after July 1, 2005, and 1645
not retiring due to work-related disability under the Public 1646
Employees' Retirement System, the health insurance coverage 1647
described in this paragraph (e) shall be available to those 1648
retiring employees only if they were participants in the State and 1649
School Employees Health Insurance Plan for four (4) years or more 1650
and are over age sixty-five (65) years or otherwise eligible for 1651
Medicare benefits, and to all dependents over age sixty-five (65) 1652
years or otherwise eligible for Medicare benefits. Benefits shall 1653
be reduced by Medicare benefits as though the Medicare benefits 1654
were the base plan. 1655
All covered individuals shall be assumed to have full 1656
Medicare coverage, Parts A and B; and any Medicare payments under 1657
both Parts A and B shall be computed to reduce benefits payable 1658
under this plan. 1659
(f) Lifetime maximum: The lifetime maximum amount of 1660
benefits payable under the health insurance plan for each 1661
participant is Two Million Dollars ($2,000,000.00). 1662
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(2) Nonduplication of benefits — reduction of benefits by 1663
Title XIX benefits: When benefits would be payable under more 1664
than one (1) group plan, benefits under those plans will be 1665
coordinated to the extent that the total benefits under all plans 1666
will not exceed the total expenses incurred. 1667
Benefits for hospital or surgical or medical benefits shall 1668
be reduced by any similar benefits payable in accordance with 1669
Title XIX of the Social Security Act or under any amendments 1670
thereto, or any implementing legislation. 1671
Benefits for hospital or surgical or medical benefits shall 1672
be reduced by any similar benefits payable by workers' 1673
compensation. 1674
No health care benefits under the state plan shall restrict 1675
coverage for medically appropriate treatment prescribed by a 1676
physician and agreed to by a fully informed insured, or if the 1677
insured lacks legal capacity to consent by a person who has legal 1678
authority to consent on his or her behalf, based on an insured's 1679
diagnosis with a terminal condition. As used in this paragraph, 1680
"terminal condition" means any aggressive malignancy, chronic 1681
end-stage cardiovascular or cerebral vascular disease, or any 1682
other disease, illness or condition which physician diagnoses as 1683
terminal. 1684
Not later than January 1, 2016, the state health plan shall 1685
not require a higher co-payment, deductible or coinsurance amount 1686
for patient-administered anti-cancer medications, including, but 1687
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not limited to, those orally administered or self-injected, than 1688
it requires for anti-cancer medications that are injected or 1689
intravenously administered by a health care provider, regardless 1690
of the formulation or benefit category determination by the plan. 1691
For the purposes of this paragraph, the term "anti-cancer 1692
medications" has the meaning as defined in Section 83-9-24. 1693
(3) (a) Schedule of life insurance benefits — group term: 1694
The amount of term life insurance for each active employee of a 1695
department, agency or institution of the state government shall 1696
not be in excess of One Hundred Thousand Dollars ($100,000.00), or 1697
twice the amount of the employee's annual wage to the next highest 1698
One Thousand Dollars ($1,000.00), whichever may be less, but in no 1699
case less than Thirty Thousand Dollars ($30,000.00), with a like 1700
amount for accidental death and dismemberment on a 1701
twenty-four-hour basis. The plan will further contain a premium 1702
waiver provision if a covered employee becomes totally and 1703
permanently disabled before age sixty-five (65) years. Employees 1704
retiring after June 30, 1999, shall be eligible to continue life 1705
insurance coverage in an amount of Five Thousand Dollars 1706
($5,000.00), Ten Thousand Dollars ($10,000.00) or Twenty Thousand 1707
Dollars ($20,000.00) into retirement. 1708
(b) Effective October 1, 1999, schedule of life 1709
insurance benefits — group term: The amount of term life 1710
insurance for each active employee of any school district, 1711
community/junior college, public library or university-based 1712
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program authorized under Section 37-23-31 for deaf, aphasic and 1713
emotionally disturbed children or any regular nonstudent bus 1714
driver shall not be in excess of One Hundred Thousand Dollars 1715
($100,000.00), or twice the amount of the employee's annual wage 1716
to the next highest One Thousand Dollars ($1,000.00), whichever 1717
may be less, but in no case less than Thirty Thousand Dollars 1718
($30,000.00), with a like amount for accidental death and 1719
dismemberment on a twenty-four-hour basis. The plan will further 1720
contain a premium waiver provision if a covered employee of any 1721
school district, community/junior college, public library or 1722
university-based program authorized under Section 37-23-31 for 1723
deaf, aphasic and emotionally disturbed children or any regular 1724
nonstudent bus driver becomes totally and permanently disabled 1725
before age sixty-five (65) years. Employees of any school 1726
district, community/junior college, public library or 1727
university-based program authorized under Section 37-23-31 for 1728
deaf, aphasic and emotionally disturbed children or any regular 1729
nonstudent bus driver retiring after September 30, 1999, shall be 1730
eligible to continue life insurance coverage in an amount of Five 1731
Thousand Dollars ($5,000.00), Ten Thousand Dollars ($10,000.00) or 1732
Twenty Thousand Dollars ($20,000.00) into retirement. 1733
(4) Any eligible employee who on March 1, 1971, was 1734
participating in a group life insurance program that has 1735
provisions different from those included in this article and for 1736
which the State of Mississippi was paying a part of the premium 1737
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may, at his discretion, continue to participate in that plan. The 1738
employee shall pay in full all additional costs, if any, above the 1739
minimum program established by this article. Under no 1740
circumstances shall any individual who begins employment with the 1741
state after March 1, 1971, be eligible for the provisions of this 1742
subsection. 1743
(5) The board may offer medical savings accounts as defined 1744
in Section 71-9-3 as a plan option. 1745
(6) Any premium differentials, differences in coverages, 1746
discounts determined by risk or by any other factors shall be 1747
uniformly applied to all active employees participating in the 1748
insurance plan. It is the intent of the Legislature that the 1749
state contribution to the plan be the same for each employee 1750
throughout the state. 1751
(7) On October 1, 1999, any school district, 1752
community/junior college district or public library may elect to 1753
remain with an existing policy or policies of group life insurance 1754
with an insurance company approved by the State and School 1755
Employees Health Insurance Management Board, in lieu of 1756
participation in the State and School Life Insurance Plan. On or 1757
after July 1, 2004, until October 1, 2004, any school district, 1758
community/junior college district or public library may elect to 1759
choose a policy or policies of group life insurance existing on 1760
October 1, 1999, with an insurance company approved by the State 1761
and School Employees Health Insurance Management Board in lieu of 1762
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participation in the State and School Life Insurance Plan. The 1763
state's contribution of up to fifty percent (50%) of the active 1764
employee's premium under the State and School Life Insurance Plan 1765
may be applied toward the cost of coverage for full-time employees 1766
participating in the approved life insurance company group plan. 1767
For purposes of this subsection (7), "life insurance company group 1768
plan" means a plan administered or sold by a private insurance 1769
company. After October 1, 1999, the board may assess charges in 1770
addition to the existing State and School Life Insurance Plan 1771
rates to such employees as a condition of enrollment in the State 1772
and School Life Insurance Plan. In order for any life insurance 1773
company group plan to be approved by the State and School 1774
Employees Health Insurance Management Board under this subsection 1775
(7), it shall meet the following criteria: 1776
(a) The insurance company offering the group life 1777
insurance plan shall be rated "A-" or better by A.M. Best state 1778
insurance rating service and be licensed as an admitted carrier in 1779
the State of Mississippi by the Mississippi Department of 1780
Insurance. 1781
(b) The insurance company group life insurance plan 1782
shall provide the same life insurance, accidental death and 1783
dismemberment insurance and waiver of premium benefits as provided 1784
in the State and School Life Insurance Plan. 1785
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(c) The insurance company group life insurance plan 1786
shall be fully insured, and no form of self-funding life insurance 1787
by the company shall be approved. 1788
(d) The insurance company group life insurance plan 1789
shall have one (1) composite rate per One Thousand Dollars 1790
($1,000.00) of coverage for active employees regardless of age and 1791
one (1) composite rate per One Thousand Dollars ($1,000.00) of 1792
coverage for all retirees regardless of age or type of retiree. 1793
(e) The insurance company and its group life insurance 1794
plan shall comply with any administrative requirements of the 1795
State and School Employees Health Insurance Management Board. If 1796
any insurance company providing group life insurance benefits to 1797
employees under this subsection (7) fails to comply with any 1798
requirements specified in this subsection or any administrative 1799
requirements of the board, the state shall discontinue providing 1800
funding for the cost of that insurance. 1801
SECTION 27. Section 25-15-13, Mississippi Code of 1972, is 1802
brought forward as follows: 1803
25-15-13. Each eligible employee may participate in the 1804
plan by signing up for the plan at the time of employment. Each 1805
eligible employee who declines coverage under the plan must sign a 1806
waiver of coverage. After acceptance in the plan, the employee 1807
may cease his or her participation by filing a specific disclaimer 1808
with the board. Forms for this purpose shall be prescribed and 1809
issued by the board. All eligible employees will be eligible to 1810
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participate in the plan on the effective date of the plan or on 1811
the date on which they are employed by the state, whichever is 1812
later, provided they make the necessary contributions as provided 1813
in this article. Spouses of employees, unmarried dependent 1814
children from birth to age nineteen (19) years, unmarried 1815
dependent children who are full-time students up to age 1816
twenty-five (25) years, and children with physical or mental 1817
disabilities, regardless of age, are eligible under the plan as of 1818
the date the employee becomes eligible. If both spouses are 1819
eligible employees who participate in the plan, the benefits shall 1820
apply individually to each spouse by virtue of his or her 1821
participation in the plan. If those spouses also have one or more 1822
eligible dependents participating in the plan, the cost of their 1823
dependents shall be calculated at a special family plan rate. The 1824
cost for participation by the dependents shall be paid by the 1825
spouse who elects to carry such dependents under his or her 1826
coverage. 1827
SECTION 28. Section 25-15-14, Mississippi Code of 1972, is 1828
brought forward as follows: 1829
25-15-14. Any elected state or district official who does 1830
not run for reelection or who is defeated before being entitled to 1831
receive a retirement allowance shall be eligible to continue to 1832
participate in the State and School Employees Health Insurance 1833
Plan under the same conditions and coverages for retired 1834
employees. 1835
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SECTION 29. Section 25-15-15, Mississippi Code of 1972, is 1836
brought forward as follows: 1837
25-15-15. (1) The board is authorized to determine the 1838
manner in which premiums and contributions by the state agencies, 1839
local school districts, colleges, universities, community/junior 1840
colleges and public libraries shall be collected to provide the 1841
self-insured health insurance program for employees as provided 1842
under this article. The state shall provide fifty percent (50%) 1843
of the cost of the above life insurance plan for all active 1844
full-time employees. The state shall provide one hundred percent 1845
(100%) of the cost of the health insurance plan for active 1846
full-time employees initially employed before January 1, 2006, 1847
except as otherwise provided in this section. For active 1848
full-time employees initially employed on or after January 1, 1849
2006, the state shall provide one hundred percent (100%) of the 1850
cost of a basic level of health insurance, except as otherwise 1851
provided in this section, and the employees may pay additional 1852
amounts to purchase additional benefits or levels of coverage 1853
offered under the plan. The board, if determined to be necessary, 1854
may assess active full-time employees a portion of the active 1855
employee premium in an amount not to exceed Twenty Dollars 1856
($20.00) per month, notwithstanding any language in this section 1857
to the contrary. All active full-time employees shall be given 1858
the opportunity to purchase coverage for their eligible dependents 1859
with the premiums for such dependent coverage, as well as the 1860
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employee's fifty percent (50%) share for his life insurance 1861
coverage, to be deductible from the employee's salary by the 1862
agency, department or institution head, which deductions, together 1863
with the fifty percent (50%) share of such life insurance premiums 1864
of such employing agency, department or institution head from 1865
funds appropriated to or authorized to be expended by the 1866
employing agency, department or institution head, shall be 1867
deposited directly into a depository bank or special fund in the 1868
State Treasury, as determined by the board. These funds and 1869
interest earned on these funds may be used for the disbursement of 1870
claims and shall be exempt from the appropriation process. 1871
(2) The state shall provide annually, by line item in the 1872
Mississippi Library Commission appropriation bill, such funds to 1873
pay one hundred percent (100%) of the cost of health insurance 1874
under the State and School Employees Health Insurance Plan, or any 1875
lesser percentage of the cost that is not assessed to the 1876
employees by the board, for full-time library staff members in 1877
each public library in Mississippi initially employed before 1878
January 1, 2006. For full-time library staff members initially 1879
employed on or after January 1, 2006, the state shall provide one 1880
hundred percent (100%) of the cost of a basic level of health 1881
insurance under the State and School Employees Health Insurance 1882
Plan, or any lesser percentage of the cost that is not assessed to 1883
the employees by the board, and the employees may pay additional 1884
amounts to purchase additional benefits or levels of coverage 1885
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offered under the plan. The commission shall allot to each public 1886
library a sufficient amount of those funds appropriated to pay the 1887
costs of insurance for eligible employees. Any funds so 1888
appropriated by line item which are not expended during the fiscal 1889
year for which such funds were appropriated shall be carried 1890
forward for the same purposes during the next succeeding fiscal 1891
year. If any premiums for the health insurance and/or late 1892
charges and interest penalties are not paid by a public library in 1893
a timely manner, as defined by the board, the Mississippi Library 1894
Commission, upon notice by the board, shall immediately withhold 1895
all subsequent disbursements of funds to that public library. 1896
(3) The state shall annually provide one hundred percent 1897
(100%) of the cost of the health insurance plan, or any lesser 1898
percentage of the cost that is not assessed to the employees by 1899
the board, for public school district employees who work no less 1900
than twenty (20) hours during each week and regular nonstudent 1901
school bus drivers, if such employees and school bus drivers were 1902
initially employed before January 1, 2006. For such employees and 1903
school bus drivers initially employed on or after January 1, 2006, 1904
the state shall provide one hundred percent (100%) of the cost of 1905
a basic level of health insurance under the State and School 1906
Employees Health Insurance Plan, or any lesser percentage of the 1907
cost that is not assessed to the employees by the board, and the 1908
employees may pay additional amounts to purchase additional 1909
benefits or levels of coverage offered under the plan. Where 1910
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federal funding is allowable to defray, in full or in part, the 1911
cost of participation in the program by district employees who 1912
work no less than twenty (20) hours during the week and regular 1913
nonstudent bus drivers, whose salaries are paid, in full or in 1914
part, by federal funds, the allowance under this section shall be 1915
reduced to the extent of such federal funding. Where the use of 1916
federal funds is allowable but not available, it is the intent of 1917
the Legislature that school districts contribute the cost of 1918
participation for such employees from local funds, except that 1919
parent fees for child nutrition programs shall not be increased to 1920
cover such cost. 1921
(4) The state shall provide annually, by line item in the 1922
community/junior college appropriation bill, such funds to pay one 1923
hundred percent (100%) of the cost of the health insurance plan, 1924
or any lesser percentage of the cost that is not assessed to the 1925
employees by the board, for community/junior college district 1926
employees initially employed before January 1, 2006, who work no 1927
less than twenty (20) hours during each week. For such employees 1928
initially employed on or after January 1, 2006, the state shall 1929
provide one hundred percent (100%) of the cost of a basic level of 1930
health insurance under the State and School Employees Health 1931
Insurance Plan, or any lesser percentage of the cost that is not 1932
assessed to the employees by the board, and the employees may pay 1933
additional amounts to purchase additional benefits or levels of 1934
coverage offered under the plan. 1935
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(5) When the use of federal funding is allowable to defray, 1936
in full or in part, the cost of participation in the insurance 1937
plan by community/junior college district employees who work no 1938
less than twenty (20) hours during each week, whose salaries are 1939
paid, in full or in part, by federal funds, the allowance under 1940
this section shall be reduced to the extent of the federal 1941
funding. Where the use of federal funds is allowable but not 1942
available, it is the intent of the Legislature that 1943
community/junior college districts contribute the cost of 1944
participation for such employees from local funds. 1945
(6) Any community/junior college district may contribute to 1946
the cost of coverage for any district employee from local 1947
community/junior college district funds, and any public school 1948
district may contribute to the cost of coverage for any district 1949
employee from nonminimum program funds. Any part of the cost of 1950
such coverage for participating employees of public school 1951
districts and public community/junior college districts that is 1952
not paid by the state shall be paid by the participating 1953
employees, which shall be deducted from the salaries of the 1954
employees in a manner determined by the board. 1955
(7) Any funds appropriated for the cost of insurance by line 1956
item in the community/junior colleges appropriation bill which are 1957
not expended during the fiscal year for which such funds were 1958
appropriated shall be carried forward for the same purposes during 1959
the next succeeding fiscal year. 1960
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(8) The board may establish and enforce late charges and 1961
interest penalties or other penalties for the purpose of requiring 1962
the prompt payment of all premiums for life and health insurance 1963
permitted under this chapter. All funds in excess of the amount 1964
needed for disbursement of claims shall be deposited in a special 1965
fund in the State Treasury to be known as the State and School 1966
Employees Insurance Fund. The State Treasurer shall invest all 1967
funds in the State and School Employees Insurance Fund and all 1968
interest earned shall be credited to the State and School 1969
Employees Insurance Fund. Such funds shall be placed with one or 1970
more depositories of the state and invested on the first day such 1971
funds are available for investment in certificates of deposit, 1972
repurchase agreements or in United States Treasury bills or as 1973
otherwise authorized by law for the investment of Public 1974
Employees' Retirement System funds, as long as such investment is 1975
made from competitive offering and at the highest and best market 1976
rate obtainable consistent with any available investment 1977
alternatives; however, such investments shall not be made in 1978
shares of stock, common or preferred, or in any other investments 1979
which would mature more than one (1) year from the date of 1980
investment. The board shall have the authority to draw from this 1981
fund periodically such funds as are necessary to operate the 1982
self-insurance plan or to pay to the insurance carrier the cost of 1983
operation of this plan, it being the purpose to limit the amount 1984
of participation by the state to fifty percent (50%) of the cost 1985
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of the life insurance program and not to limit the contracting for 1986
additional benefits where the cost will be paid in full by the 1987
employee. The state shall not share in the cost of coverage for 1988
retired employees. 1989
(9) The board shall also provide for the creation of an 1990
Insurance Reserve Fund and funds therein shall be invested by the 1991
State Treasurer with all interest earned credited to the State and 1992
School Employees Insurance Fund. 1993
(10) Any retired employee electing to purchase retired life 1994
and health insurance will have the full cost of such insurance 1995
deducted monthly from his State of Mississippi retirement plan 1996
check or direct billed for the cost of the premium if the 1997
retirement check is insufficient to pay for the premium. If the 1998
board determines actuarially that the premium paid by the 1999
participating retirees adversely affects the overall cost of the 2000
plan to the state, then the board may impose a premium surcharge, 2001
not to exceed fifteen percent (15%), upon such participating 2002
retired employees who are under the age for Medicare eligibility 2003
and who were initially employed before January 1, 2006. For 2004
participating retired employees who are under the age for Medicare 2005
eligibility and who were initially employed on or after January 1, 2006
2006, the board may impose a premium surcharge in an amount the 2007
board determines actuarially to cover the full cost of insurance. 2008
(11) This section shall stand repealed on July 1, 2026. 2009
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SECTION 30. Section 25-15-16, Mississippi Code of 1972, is 2010
brought forward as follows: 2011
25-15-16. The public school districts of the state, in their 2012
discretion, may pay with local funds one hundred percent (100%) of 2013
the cost of the health insurance premiums of the State and School 2014
Employees Health Insurance Plan for all retired members of the 2015
Public Employees' Retirement System who are employed as school bus 2016
drivers by the school districts. No state funds shall be used for 2017
payment of the health insurance premiums under the authority of 2018
this section. If a school district chooses to pay the health 2019
insurance premiums for school bus drivers under the authority of 2020
this section, the district shall be authorized to pay any amount 2021
that is one hundred percent (100%) or less of the cost of the 2022
health insurance premiums for the school bus drivers. 2023
SECTION 31. Section 25-15-17, Mississippi Code of 1972, is 2024
brought forward as follows: 2025
25-15-17. (1) Any benefits payable under the plan may be 2026
made either directly to the attending physicians, hospitals, 2027
medical groups, or others furnishing the services upon which a 2028
claim is based, or to the covered employee, upon presentation of 2029
valid bills for such services, subject to subsection (3) of this 2030
section and such provisions to facilitate payment as may be made 2031
by the board. All benefits payable under this plan shall be 2032
payable directly to the covered employee unless such covered 2033
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employee shall make a valid assignment in accordance with 2034
subsection (3) of this section. 2035
(2) The plan may not, by its terms, limit or restrict the 2036
covered employee's ability to assign the covered employee's 2037
benefits under the policy to a licensed health care provider that 2038
provides health care services to the covered employee. Any such 2039
plan provision in violation of this subsection shall be invalid. 2040
(3) If the covered employee provides the board with written 2041
direction that all or a portion of any indemnities or benefits 2042
provided by the plan be paid to a licensed health care provider 2043
rendering hospital, nursing, medical or surgical services, then 2044
the plan shall pay directly the licensed health care provider 2045
rendering such services. That payment shall be considered payment 2046
in full to the provider, who may not bill or collect from the 2047
covered employee any amount above that payment, other than the 2048
deductible, coinsurance, copayment or other charges for equipment 2049
or services requested by the covered employee that are noncovered 2050
benefits after the signing of an explanatory document about the 2051
noncovered benefit by the covered employee. 2052
SECTION 32. Section 25-15-19, Mississippi Code of 1972, is 2053
brought forward as follows: 2054
25-15-19. On or before July 1, 1972, the board shall notify 2055
all department, agency and institution heads that the employee 2056
deductions shall commence on said date. 2057
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SECTION 33. Section 25-15-23, Mississippi Code of 1972, is 2058
brought forward as follows: 2059
25-15-23. No agency, board, school district, 2060
community/junior college, public library, university, institution 2061
or authority of the state shall withdraw, or authorize any agency 2062
or institution under its management and control to withdraw, from 2063
the State and School Employees Life and Health Insurance Plan 2064
established under this chapter. 2065
SECTION 34. Section 41-149-5, Mississippi Code of 1972, is 2066
brought forward as follows: 2067
41-149-5. Prohibition of certain discriminatory actions 2068
related to reimbursement of 340B entities. (1) With respect to 2069
reimbursement to a 340B entity for 340B drugs, a health insurance 2070
issuer, pharmacy benefit manager, other third-party payor, or its 2071
agent shall not do any of the following: 2072
(a) Reimburse a 340B entity for 340B drugs at a rate 2073
lower than that paid for the same drug to entities that are not 2074
340B entities or lower reimbursement for a claim on the basis that 2075
the claim is for a 340B drug. 2076
(b) Impose any terms or conditions on any 340B entity 2077
with respect to any of the following that differ from such terms 2078
or conditions applied to non-340B entities on the basis that the 2079
entity participates in the federal 340B drug discount program set 2080
forth in 42 USC 256b or that a drug is a 340B drug including, 2081
without limitation, any of the following: 2082
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(i) Fees, charges, clawbacks, or other adjustments 2083
or assessments. For purposes of this item 1, the term "other 2084
adjustment" includes placing any additional requirements, 2085
restrictions, or unnecessary burdens upon the 340B entity that 2086
results in administrative costs or fees to the 340B entity that 2087
are not placed upon other entities that do not participate in the 2088
340B drug discount program, including affiliate pharmacies of the 2089
health insurance issuer, pharmacy benefit manager, or other 2090
third-party payor. 2091
(ii) Dispensing fees that are less than the 2092
dispensing fees for non-340B entities. 2093
(iii) Restrictions or requirements regarding 2094
participation in standard or preferred pharmacy networks. 2095
(iv) Requirements relating to the frequency or 2096
scope of audits of inventory management systems. 2097
(v) Requirements that a claim for a drug include 2098
any identification, billing modifier, attestation, or other 2099
indication that a drug is a 340B drug in order to be processed or 2100
resubmitted unless it is required by the Centers for Medicare and 2101
Medicaid Services or the Division of Medicaid for the 2102
administration of the Mississippi Medicaid program. 2103
(vi) Any other restrictions, conditions, 2104
practices, or policies that are not imposed on non-340B entities. 2105
(c) Require a 340B entity to reverse, resubmit, or 2106
clarify a claim after the initial adjudication unless these 2107
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actions are in the normal course of pharmacy business and not 2108
related to 340B drug pricing. 2109
(d) Discriminate against a 340B entity in a manner that 2110
prevents or interferes with any patient's choice to receive such 2111
drugs from the 340B entity, including the administration of such 2112
drugs. For purposes of this subparagraph (iv), it is considered a 2113
discriminatory practice that prevents or interferes with a 2114
patient's choice to receive drugs at a 340B entity if a health 2115
insurance issuer, pharmacy benefit manager, or other third-party 2116
payor places any additional requirements, restrictions, or 2117
unnecessary burdens upon the 340B entity that results in 2118
administrative costs or fees to the 340B entity, including but not 2119
limited to requiring a claim for a drug to include any 2120
identification, billing modifier, attestation or other indication 2121
that a drug is a 340B drug in order to be processed or resubmitted 2122
unless it is required by the Centers for Medicare and Medicaid 2123
Services or the Division of Medicaid in administration of the 2124
Mississippi Medicaid program. 2125
(e) Include any other provision in a contract between a 2126
health insurance issuer, pharmacy benefit manager, or other 2127
third-party payor and a 340B entity that discriminates against the 2128
340B entity or prevents or interferes with an individual's choice 2129
to receive a prescription drug from a 340B entity, including the 2130
administration of the drug, in person or via direct delivery, 2131
mail, or other form of shipment, or creation of a restriction or 2132
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additional charge on a patient who chooses to receive drugs from a 2133
340B entity. 2134
(f) Require or compel the submission of ingredient 2135
costs or pricing data pertaining to 340B drugs to any health 2136
insurance issuer, pharmacy benefit manager, or other third-party 2137
payor. 2138
(g) Exclude any 340B entity from the health insurance 2139
issuer, pharmacy benefit manager, or other third-party payor 2140
network on the basis that the 340B entity dispenses drugs subject 2141
to an agreement under 42 USC 256b, or refusing to contract with a 2142
340B entity for reasons other than those that apply equally to 2143
non-340B entities. 2144
(2) Nothing in this chapter applies to the Mississippi 2145
Medicaid program as payor when Medicaid provides reimbursement for 2146
covered outpatient drugs as defined in 42 USC 1396r-8(k). 2147
SECTION 35. Section 41-151-7, Mississippi Code of 1972, is 2148
brought forward as follows: 2149
41-151-7. (1) A health insurance issuer, pharmacy benefit 2150
manager, or the agent of either shall not: 2151
(a) Refuse to authorize, approve, or pay a 2152
participating provider for providing covered 2153
physician-administered drugs and related covered services to 2154
covered persons; or 2155
(b) Require a covered person to pay any penalty or 2156
additional fee not otherwise applicable to cost-sharing amounts 2157
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payable by the covered person as designated within the benefit 2158
plan to obtain the physician-administered drug when provided by a 2159
participating provider. 2160
(2) All provider agreements are hereby construed to include 2161
a provision that requires that when all criteria for medical 2162
necessity are met, that the drug and its administration will be 2163
payable irrespective of whether the participating provider obtains 2164
physician-administered drugs from a pharmacy that is not a 2165
participating provider in the health insurance issuer's network. 2166
The drug supplied shall meet the supply chain security controls 2167
and chain of distribution set by the federal Drug Supply Chain 2168
Security Act. 2169
(3) The payment to a participating provider shall be at the 2170
rate set forth in the health insurance issuer's agreement with the 2171
participating provider applicable to such drugs, or if no such 2172
rate is included in the agreement, then at the wholesale 2173
acquisition cost. 2174
(4) Any provision of a contract that is contrary to any 2175
provision of this chapter shall be null, void, and unenforceable 2176
in this state. 2177
SECTION 36. Section 73-21-205, Mississippi Code of 1972, is 2178
brought forward as follows: 2179
73-21-205. (1) (a) Pharmacists may provide additional 2180
information to a patient to allow them an opportunity to consider 2181
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affordable alternative payment options when acquiring their 2182
prescription medication. 2183
(b) Any provision of any contract or agreement contrary 2184
to the provisions of Sections 73-21-201 through 73-21-205 shall be 2185
considered in violation of public policy and shall be void. 2186
(2) Compliance with this section shall not constitute a 2187
violation of any contract or provision of any agreement to which 2188
the pharmacist or pharmacy is a party. 2189
(3) Neither the board, any pharmacy benefit manager nor any 2190
third party shall penalize a pharmacist for acting or failing to 2191
act under this section, nor shall a pharmacist or his agents or 2192
employees be liable for any act or failure to act under this 2193
section. 2194
SECTION 37. If the application or operation of any section, 2195
subsection, paragraph, sentence, clause, word or provision of this 2196
act shall be enjoined or otherwise made inoperative by a court of 2197
competent jurisdiction on the grounds that state or federal law 2198
invalidates the application or operation thereof, this act shall 2199
be valid and effective in all other applications and operations, 2200
and no section, subsection, paragraph, sentence, clause, word or 2201
other provision shall on account of any pending litigation be 2202
deemed invalid or ineffective except as to that language which has 2203
been enjoined or otherwise made inoperative, then only until the 2204
injunction is removed. 2205
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SECTION 38. The following shall be codified as Section 2206
73-21-171, Mississippi Code of 1972: 2207
73-21-171. Sections 73-21-151 through 73-21-169, Mississippi 2208
Code of 1972, which are the provisions of the Pharmacy Benefit 2209
Prompt Pay Act, shall stand repealed on July 1, 2029. 2210
SECTION 39. The following shall be codified as Section 2211
25-15-307, Mississippi Code of 1972: 2212
25-15-307. Sections 25-15-301 through 25-15-305, Mississippi 2213
Code of 1972, which relate to the administration of group 2214
insurance plans for public employees, shall stand repealed on July 2215
1, 2029. 2216
SECTION 40. This act shall take effect and be in force from 2217
and after July 1, 2026. 2218