Pharmacy Benefit Prompt Act; revise.

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To: State Affairs; Ways and
Means
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Zuber

HOUSE BILL NO. 1666

AN ACT TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, 1
TO REFERENCE NEW SECTIONS IN THE PHARMACY BENEFIT PROMPT PAY ACT; 2
TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE 3
NEW TERMS AND REVISE THE DEFINITIONS OF EXISTING TERMS UNDER THE 4
PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-155, 5
MISSISSIPPI CODE OF 1972, TO DELETE DEFINITIONS FOR "CLEAN CLAIM" 6
AND "NETWORK PHARMACY", WHICH ARE INCLUDED IN THE DEFINITIONS 7
SECTION; TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO 8
REQUIRE PHARMACY BENEFIT MANAGERS TO PROVIDE REASONABLE 9
ADMINISTRATIVE APPEAL PROCEDURES TO ALLOW PHARMACIES TO CHALLENGE 10
A REIMBURSEMENT FOR A SPECIFIC DRUG OR DRUGS AS BEING BELOW THE 11
REIMBURSEMENT RATE REQUIRED BY THE PRECEDING PROVISION; TO PROVIDE 12
THAT IF THE APPEAL IS UPHELD, THE PHARMACY BENEFIT MANAGER SHALL 13
MAKE THE CHANGE IN THE PAYMENT TO THE REQUIRED REIMBURSEMENT RATE 14
FOR THAT PHARMACY; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 15
1972, TO REQUIRE A PHARMACY SERVICES ADMINISTRATIVE ORGANIZATION 16
(PSAO) TO BE LICENSED BY THE STATE BOARD OF PHARMACY; TO REQUIRE A 17
PSAO TO PROVIDE TO A PHARMACY OR PHARMACIST A COPY OF ANY CONTRACT 18
ENTERED INTO ON BEHALF OF THE PHARMACY OR PHARMACIST BY THE PSAO; 19
TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO 20
PROHIBIT A PHARMACY BENEFIT MANAGER, PSAO, CARRIER OR HEALTH PLAN 21
FROM SPREAD PRICING; TO PROHIBIT PHARMACY BENEFIT MANAGERS FROM 22
REIMBURSING A PHARMACY OR PHARMACIST IN THE STATE AN AMOUNT LESS 23
THAN THE AMOUNT REIMBURSED TO A PHARMACY BENEFIT MANAGER AFFILIATE 24
FOR THE SAME DRUG; TO PROVIDE THAT PHARMACY BENEFIT MANAGERS AND 25
HEALTH PLANS ARE NOT PROHIBITED FROM APPLYING BONA FIDE 26
VOLUME-BASED DISCOUNTS, REBATES OR OTHER PRICE CONCESSIONS TO 27
IN-NETWORK PHARMACIES ON TERMS EQUAL TO SIMILARLY SITUATED 28
IN-NETWORK PHARMACIES, INCLUDING PHARMACY BENEFIT MANAGER 29
AFFILIATE PHARMACIES; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI 30
CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS, PHARMACY 31
BENEFIT MANAGER AFFILIATES AND PHARMACY SERVICES ADMINISTRATIVE 32
ORGANIZATIONS (PSAOS) FROM PENALIZING OR RETALIATING AGAINST A 33
PHARMACIST, PHARMACY OR PHARMACY EMPLOYEE FOR EXERCISING ANY 34
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RIGHTS UNDER THIS ACT, INITIATING ANY JUDICIAL OR REGULATORY 35
ACTIONS, OR APPEARING BEFORE ANY GOVERNMENTAL AGENCY, LEGISLATIVE 36
MEMBER OR BODY OR ANY JUDICIAL AUTHORITY; TO AMEND SECTION 37
73-21-163, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE BOARD OF 38
PHARMACY, FOR THE PURPOSES OF CONDUCTING INVESTIGATIONS, TO 39
CONDUCT EXAMINATIONS OF A PHARMACY BENEFIT MANAGER OR PSAO AND TO 40
ISSUE SUBPOENAS TO OBTAIN DOCUMENTS OR RECORDS THAT IT DEEMS 41
RELEVANT TO THE INVESTIGATION; TO CREATE NEW SECTION 73-21-165, 42
MISSISSIPPI CODE OF 1972, TO REQUIRE EACH DRUG MANUFACTURER TO 43
SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES THE CURRENT 44
WHOLESALE ACQUISITION COST; TO REQUIRE SUCH ENTITIES TO PROVIDE 45
THE BOARD OF PHARMACY WITH VARIOUS DRUG PRICING INFORMATION WITHIN 46
A CERTAIN TIME; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO 47
FILE A REPORT WITH THE BOARD OF PHARMACY; TO REQUIRE EACH HEALTH 48
INSURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES 49
CERTAIN DRUG PRESCRIPTION INFORMATION; TO CREATE NEW SECTION 50
73-21-167, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD OF 51
PHARMACY TO DEVELOP A WEBSITE TO PUBLISH INFORMATION RELATED TO 52
THE ACT; TO CREATE NEW SECTION 73-21-169, MISSISSIPPI CODE OF 53
1972, TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO IDENTIFY 54
OWNERSHIP AFFILIATION OF ANY KIND TO THE BOARD OF PHARMACY; TO 55
CREATE THE MISSISSIPPI INDEPENDENT PHARMACIST REIMBURSEMENT 56
ASSISTANCE GRANT PROGRAM TO PROVIDE FINANCIAL ASSISTANCE TO 57
ELIGIBLE INDEPENDENT COMMUNITY PHARMACIES IN THE STATE; TO REQUIRE 58
THE STATE BOARD OF PHARMACY TO ADMINISTER THE PROGRAM; TO 59
ESTABLISH GRANT ELIGIBILITY CRITERIA; TO PROVIDE THAT FUNDING FOR 60
THE PROGRAM SHALL BE THROUGH LEGISLATIVE APPROPRIATIONS, GRANTS 61
AND DONATIONS; TO REQUIRE ANNUAL REPORTS ON THE PROGRAM; TO 62
PROVIDE THAT THE ACT MAY NOT BE CONSTRUED TO IMPOSE A FIDUCIARY 63
DUTY ON A PHARMACY BENEFIT MANAGER OR HEALTH INSURER WHICH IS 64
INCONSISTENT WITH FEDERAL LAW, TO PROHIBIT PHARMACY BENEFIT 65
MANAGERS FROM DESIGNING FORMULARIES, BENEFIT TIERS AND NETWORKS TO 66
MANAGE COST, TO LIMIT PHARMACY BENEFIT MANAGERS' ABILITY TO 67
NEGOTIATE VOLUME-BASED DISCOUNTS OR REBATES, OR TO REQUIRE HEALTH 68
BENEFIT PLANS TO INCLUDE ALL WILLING PHARMACIES IN ITS PREFERRED 69
NETWORK; AND FOR RELATED PURPOSES. 70
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 71
SECTION 1. Section 73-21-151, Mississippi Code of 1972, is 72
amended as follows: 73
73-21-151. Sections 73-21-151 through * * * 73-21-169 shall 74
be known as the "Pharmacy Benefit Prompt Pay Act." 75
SECTION 2. Section 73-21-153, Mississippi Code of 1972, is 76
amended as follows: 77
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73-21-153. For purposes of Sections 73-21-151 through * * * 78
73-21-169, the following words and phrases shall have the meanings 79
ascribed herein unless the context clearly indicates otherwise: 80
(a) "Board" means the State Board of Pharmacy. 81
(b) "Clean claim" means a completed billing instrument, 82
paper or electronic, received by a pharmacy benefit manager from a 83
pharmacist or pharmacies or the insured, which is accepted and 84
payment remittance advice is provided by the pharmacy benefit 85
manager. A clean claim includes resubmitted claims with 86
previously identified deficiencies corrected. 87
( * * *c) "Commissioner" means the Mississippi 88
Commissioner of Insurance. 89
( * * *d) "Day" means a calendar day, unless otherwise 90
defined or limited. 91
( * * *e) "Electronic claim" means the transmission of 92
data for purposes of payment of covered prescription drugs, other 93
products and supplies, and pharmacist services in an electronic 94
data format specified by a pharmacy benefit manager and approved 95
by the department. 96
( * * *f) "Electronic adjudication" means the process 97
of electronically receiving * * * and reviewing an electronic 98
claim and either accepting and providing payment remittance advice 99
for the electronic claim or rejecting * * * the electronic claim. 100
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( * * *g) "Enrollee" means an individual who has been 101
enrolled in a pharmacy benefit management plan or health insurance 102
plan. 103
( * * *h) "Health insurance plan" means benefits 104
consisting of prescription drugs, other products and supplies, and 105
pharmacist services provided directly, through insurance or 106
reimbursement, or otherwise and including items and services paid 107
for as prescription drugs, other products and supplies, and 108
pharmacist services under any hospital or medical service policy 109
or certificate, hospital or medical service plan contract, 110
preferred provider organization agreement, or health maintenance 111
organization contract offered by a health insurance issuer. 112
(i) "Network pharmacy" means a pharmacy licensed by the 113
board and provides pharmacy services to Mississippi consumers and 114
has a contract with a pharmacy benefit manager to provide covered 115
drugs at a negotiated reimbursement rate. 116
(j) "Payment remittance advice" means the claim detail 117
that the pharmacy receives when successfully processing an 118
electronic or paper claim. The claim detail shall contain, but is 119
not limited to: 120
(i) The amount that the pharmacy benefit manager 121
will reimburse for product ingredient; and 122
(ii) The amount that the pharmacy benefit manager 123
will reimburse for product dispensing fee; and 124
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(iii) The amount that the pharmacy benefit manager 125
dictates the patient must pay. 126
(k) "Pharmacist * * *" and "pharmacy" or "pharmacies" 127
shall have the same definitions as provided in Section 73-21-73. 128
( * * *l) "Pharmacy benefit manager" * * * means an 129
entity that provides pharmacy benefit management services. * * * 130
The term "pharmacy benefit manager" shall not include: 131
(i) An insurance company unless the insurance 132
company is providing services as a pharmacy benefit manager * * *, 133
in which case the insurance company shall be subject to Sections 134
73-21-151 through * * * 73-21-169 only for those pharmacy benefit 135
manager services * * *; and 136
(ii) The Mississippi Division of Medicaid or its 137
contractors when performing pharmacy benefit manager services for 138
the Division of Medicaid. 139
( * * *m) "Pharmacy benefit manager affiliate" 140
means * * * an entity that, directly or indirectly, * * * owns or 141
controls, is owned or controlled by, or is under common ownership 142
or control with a pharmacy benefit manager. 143
( * * *n) "Pharmacy benefit management plan" * * * 144
means an arrangement for the delivery of pharmacist's services in 145
which a pharmacy benefit manager undertakes to administer the 146
payment or reimbursement of any of the costs of pharmacist's 147
services, drugs or devices. 148
* * * 149
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(o) "Pharmacy benefit management services" includes, 150
but is not limited to, the following services, which may be 151
provided either directly or through outsourcing or contracts: 152
(i) Adjudicate drug claims or any portion of the 153
transaction. 154
(ii) Contract with retail and mail pharmacy 155
networks. 156
(iii) Establish payment levels for pharmacies. 157
(iv) Develop formulary or drug list of covered 158
therapies. 159
(v) Provide benefit design consultation. 160
(vi) Manage cost and utilization trends. 161
(vii) Contract for manufacturer rebates. 162
(viii) Provide fee-based clinical services to 163
improve member care; and 164
(ix) Third-party administration. 165
(p) "Pharmacist services" means products, goods and 166
services, or any combination of products, goods and services, 167
provided as part of the practice of pharmacy. 168
(q) "Pharmacy services administrative organization" or 169
"PSAO" means any entity that contracts with a pharmacy or 170
pharmacist to assist with third-party interactions and that may 171
provide a variety of other administrative services, including, but 172
not limited to, contracting with pharmacy benefit managers on 173
behalf of pharmacies and providing pharmacies with credentialing, 174
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billing, audit, general business and analytic support. A covered 175
entity as defined in 42 USC Section 256b, including its pharmacy 176
or the transactions related to the 340B drug discount program of 177
any pharmacy contracted with the participating covered entity to 178
dispense drugs purchased through the 340B drug discount program, 179
shall not be considered to be a pharmacy services administrative 180
organization. 181
( * * *r) "Plan sponsors" means the employers, 182
insurance companies, unions and health maintenance organizations 183
that contract, either directly or indirectly, with a pharmacy 184
benefit manager for delivery of prescription drugs or services, or 185
both. 186
(s) "Proprietary information" means information on 187
pricing, costs, revenue, taxes, market share, negotiating 188
strategies, customers and personnel that is held by a pharmacy 189
benefit manager, drug manufacturer or PSAO and used for its 190
business purposes. 191
(t) "Rebate" means any and all payments and price 192
concessions that accrue to a pharmacy benefit manager or its plan 193
sponsor client, directly or indirectly, including through an 194
affiliate, subsidiary, third party or intermediary, including 195
off-shore group purchasing organizations, from a pharmaceutical 196
manufacturer, its affiliate, subsidiary, third party or 197
intermediary, including, but not limited, to payments, discounts, 198
administration fees, credits, incentives or penalties associated 199
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directly or indirectly in any way with claims administered on 200
behalf of a plan sponsor. 201
(u) "Spread pricing" means any amount charged or 202
claimed by a pharmacy benefit manager or PSAO in excess of the 203
ingredient cost for a dispensed prescription drug plus dispensing 204
fee paid directly or indirectly to any pharmacy, pharmacist or 205
other provider on behalf of the health benefit plan, less a 206
pharmacy benefit management or PSAO fee. 207
( * * *v) "Uniform claim form" means a form prescribed 208
by rule by the * * * board; however, for purposes of Sections 209
73-21-151 through * * * 73-21-169, the board shall adopt the same 210
definition or rule where the State Department of Insurance has 211
adopted a rule covering the same type of claim. The board may 212
modify the terminology of the rule and form when necessary to 213
comply with the provisions of Sections 73-21-151 through * * * 214
73-21-169. 215
(w) "Wholesale acquisition cost" means the wholesale 216
acquisition cost of the drug as defined in 42 USC§ 217
1395w-3a(c)(6)(B). 218
SECTION 3. Section 73-21-155, Mississippi Code of 1972, is 219
amended as follows: 220
73-21-155. (1) Reimbursement under a contract to a 221
pharmacist or pharmacy for prescription drugs and other products 222
and supplies that is calculated according to a formula that uses 223
Medi-Span, Gold Standard or a nationally recognized reference that 224
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has been approved by the board in the pricing calculation shall 225
use the most current reference price or amount in the actual or 226
constructive possession of the pharmacy benefit manager, its 227
agent, or any other party responsible for reimbursement for 228
prescription drugs and other products and supplies on the date of 229
electronic adjudication or on the date of service shown on the 230
nonelectronic claim. 231
(2) Pharmacy benefit managers, their agents and other 232
parties responsible for reimbursement for prescription drugs and 233
other products and supplies shall be required to update the 234
nationally recognized reference prices or amounts used for 235
calculation of reimbursement for prescription drugs and other 236
products and supplies no less than every three (3) business days. 237
(3) (a) All benefits payable under a pharmacy benefit 238
management plan shall be paid within seven (7) days after receipt 239
of due written proof of a clean claim where claims are submitted 240
electronically, and shall be paid within thirty-five (35) days 241
after receipt of due written proof of a clean claim where claims 242
are submitted in paper format. Benefits due under the plan and 243
claims are overdue if not paid within seven (7) days or 244
thirty-five (35) days, whichever is applicable, after the pharmacy 245
benefit manager receives a clean claim containing necessary 246
information essential for the pharmacy benefit manager to 247
administer preexisting condition, coordination of benefits and 248
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subrogation provisions under the plan sponsor's health insurance 249
plan. * * * 250
(b) A clean claim does not include any of the 251
following: 252
(i) A duplicate claim, which means an original 253
claim and its duplicate when the duplicate is filed within thirty 254
(30) days of the original claim; 255
(ii) Claims which are submitted fraudulently or 256
that are based upon material misrepresentations; 257
(iii) Claims that require information essential 258
for the pharmacy benefit manager to administer preexisting 259
condition, coordination of benefits or subrogation provisions 260
under the plan sponsor's health insurance plan; or 261
(iv) Claims submitted by a pharmacist or pharmacy 262
more than thirty (30) days after the date of service; if the 263
pharmacist or pharmacy does not submit the claim on behalf of the 264
insured, then a claim is not clean when submitted more than thirty 265
(30) days after the date of billing by the pharmacist or pharmacy 266
to the insured. 267
(c) Not later than seven (7) days after the date the 268
pharmacy benefit manager actually receives an electronic claim, 269
the pharmacy benefit manager shall pay the appropriate benefit in 270
full, or any portion of the claim that is clean, and notify the 271
pharmacist or pharmacy (where the claim is owed to the pharmacist 272
or pharmacy) of the reasons why the claim or portion thereof is 273
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not clean and will not be paid and what substantiating 274
documentation and information is required to adjudicate the claim 275
as clean. Not later than thirty-five (35) days after the date the 276
pharmacy benefit manager actually receives a paper claim, the 277
pharmacy benefit manager shall pay the appropriate benefit in 278
full, or any portion of the claim that is clean, and notify the 279
pharmacist or pharmacy (where the claim is owed to the pharmacist 280
or pharmacy) of the reasons why the claim or portion thereof is 281
not clean and will not be paid and what substantiating 282
documentation and information is required to adjudicate the claim 283
as clean. Any claim or portion thereof resubmitted with the 284
supporting documentation and information requested by the pharmacy 285
benefit manager shall be paid within twenty (20) days after 286
receipt. 287
(4) If the board finds that any pharmacy benefit manager, 288
agent or other party responsible for reimbursement for 289
prescription drugs and other products and supplies has not paid 290
ninety-five percent (95%) of clean claims as defined in subsection 291
(3) of this section received from all pharmacies in a calendar 292
quarter, he shall be subject to an administrative penalty of not 293
more than Twenty-five Thousand Dollars ($25,000.00) to be assessed 294
by the State Board of Pharmacy. 295
(a) Examinations to determine compliance with this 296
subsection may be conducted by the board. The board may contract 297
with qualified impartial outside sources to assist in examinations 298
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to determine compliance. The expenses of any such examinations 299
shall be paid by the pharmacy benefit manager examined. 300
(b) Nothing in the provisions of this section shall 301
require a pharmacy benefit manager to pay claims that are not 302
covered under the terms of a contract or policy of accident and 303
sickness insurance or prepaid coverage. 304
(c) If the claim is not denied for valid and proper 305
reasons by the end of the applicable time period prescribed in 306
this provision, the pharmacy benefit manager must pay the pharmacy 307
(where the claim is owed to the pharmacy) or the patient (where 308
the claim is owed to a patient) interest on accrued benefits at 309
the rate of one and one-half percent (1-1/2%) per month accruing 310
from the day after payment was due on the amount of the benefits 311
that remain unpaid until the claim is finally settled or 312
adjudicated. Whenever interest due pursuant to this provision is 313
less than One Dollar ($1.00), such amount shall be credited to the 314
account of the person or entity to whom such amount is owed. 315
(d) Any pharmacy benefit manager and a pharmacy may 316
enter into an express written agreement containing timely claim 317
payment provisions which differ from, but are at least as 318
stringent as, the provisions set forth under subsection (3) of 319
this section, and in such case, the provisions of the written 320
agreement shall govern the timely payment of claims by the 321
pharmacy benefit manager to the pharmacy. If the express written 322
agreement is silent as to any interest penalty where claims are 323
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not paid in accordance with the agreement, the interest penalty 324
provision of subsection (4)(c) of this section shall apply. 325
(e) The State Board of Pharmacy may adopt rules and 326
regulations necessary to ensure compliance with this subsection. 327
(5) (a) * * * A network pharmacy or pharmacist may decline 328
to provide a brand name drug, multisource generic drug, or 329
service, if the network pharmacy or pharmacist is paid less than 330
that network pharmacy's acquisition cost for the product. If the 331
network pharmacy or pharmacist declines to provide such drug or 332
service, the pharmacy or pharmacist shall provide the customer 333
with adequate information as to where the prescription for the 334
drug or service may be filled. 335
(b) The State Board of Pharmacy shall adopt rules and 336
regulations necessary to implement and ensure compliance with this 337
subsection, including, but not limited to, rules and regulations 338
that address access to pharmacy services in rural or underserved 339
areas in cases where a network pharmacy or pharmacist declines to 340
provide a drug or service under paragraph (a) of this subsection. 341
* * * 342
(6) A pharmacy benefit manager shall not directly or 343
indirectly retroactively deny or reduce a claim or aggregate of 344
claims after the claim or aggregate of claims has been 345
adjudicated. 346
SECTION 4. Section 73-21-156, Mississippi Code of 1972, is 347
amended as follows: 348
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73-21-156. (1) As used in this section, the following terms 349
shall be defined as provided in this subsection: 350
(a) "Maximum allowable cost list" means a listing of 351
drugs or other methodology used by a pharmacy benefit manager, 352
directly or indirectly, setting the maximum allowable payment to a 353
pharmacy or pharmacist for a generic drug, brand-name drug, 354
biologic product or other prescription drug. The term "maximum 355
allowable cost list" includes without limitation: 356
(i) Average acquisition cost, including national 357
average drug acquisition cost; 358
(ii) Average manufacturer price; 359
(iii) Average wholesale price; 360
(iv) Brand effective rate or generic effective 361
rate; 362
(v) Discount indexing; 363
(vi) Federal upper limits; 364
(vii) Wholesale acquisition cost; and 365
(viii) Any other term that a pharmacy benefit 366
manager or a health care insurer may use to establish 367
reimbursement rates to a pharmacist or pharmacy for pharmacist 368
services. 369
(b) "Pharmacy acquisition cost" means the amount that a 370
pharmaceutical wholesaler charges for a pharmaceutical product as 371
listed on the pharmacy's billing invoice. 372
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(2) Before a pharmacy benefit manager places or continues a 373
particular drug on a maximum allowable cost list, the drug: 374
(a) If the drug is a generic equivalent drug product as 375
defined in Section 73-21-73, shall be listed as therapeutically 376
equivalent and pharmaceutically equivalent "A" or "B" rated in the 377
United States Food and Drug Administration's most recent version 378
of the "Orange Book" or "Green Book" or have an NR or NA rating by 379
Medi-Span, Gold Standard, or a similar rating by a nationally 380
recognized reference approved by the board; 381
(b) Shall be available for purchase by each pharmacy in 382
the state from national or regional wholesalers operating in 383
Mississippi; and 384
(c) Shall not be obsolete. 385
(3) A pharmacy benefit manager shall: 386
(a) Provide access to its maximum allowable cost list 387
to each pharmacy subject to the maximum allowable cost list; 388
(b) Update its maximum allowable cost list on a timely 389
basis, but in no event longer than three (3) calendar days; and 390
(c) Provide a process for each pharmacy subject to the 391
maximum allowable cost list to receive prompt notification of an 392
update to the maximum allowable cost list. 393
(4) A pharmacy benefit manager shall: 394
(a) Provide a reasonable administrative appeal 395
procedure to allow pharmacies to challenge * * * reimbursements 396
made * * * for a specific drug or drugs as: 397
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(i) Not meeting the requirements of this section; 398
or 399
(ii) Being below the pharmacy acquisition cost. 400
(b) The reasonable administrative appeal procedure 401
shall include the following: 402
(i) A * * * direct telephone number, email address 403
and website for the purpose of submitting administrative appeals; 404
(ii) The website of the pharmacy benefit manager 405
shall include easily accessible administrative appeal 406
instructions, including listing any required information to be 407
submitted by pharmacies for the purpose of submitting 408
administrative appeals; 409
( * * *iii) The ability to submit an 410
administrative appeal or a claim appeal report for multiple claims 411
directly to the pharmacy benefit manager * * * or through a * * * 412
PSAO; and 413
( * * *iv) A period of no less than thirty 414
(30) * * * days to file an administrative appeal. 415
(c) The pharmacy benefit manager shall respond to the 416
challenge under paragraph (a) of this subsection (4) within thirty 417
(30) * * * days after receipt of the challenge. 418
(d) If a challenge is made under paragraph (a) of this 419
subsection (4), the pharmacy benefit manager shall within thirty 420
(30) * * * days after receipt of the challenge either: 421
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(i) * * * Uphold the appeal * * * and adjust the 422
reimbursement paid to the pharmacist or pharmacy to no less than 423
the pharmacy acquisition cost, as documented on the pharmacist's 424
or pharmacy's billing invoice, or as provided in the claim appeal 425
report, and make the * * * adjustment effective for * * * that 426
pharmacist or pharmacy for that appeal. The pharmacy benefit 427
manager shall provide notice on its website that an appeal was 428
made and upheld and that an adjusted reimbursement was made to a 429
pharmacy or pharmacist following the appeal. The notice shall 430
include the National Drug Code, the day of service for which the 431
appeal was made and the challenged rate; or 432
(ii) * * * Deny the appeal * * * and provide the 433
challenging pharmacy or pharmacist the National Drug Code and the 434
name of the national or regional pharmaceutical wholesalers 435
operating in Mississippi that the pharmacy or pharmacist is able 436
to purchase prescription drugs for resale from and that have the 437
drug currently in stock at a price below the maximum allowable 438
cost as listed on the maximum allowable cost list; or 439
(iii) If the National Drug Code provided by the 440
pharmacy benefit manager is not available below the pharmacy 441
acquisition cost from the pharmaceutical wholesaler from whom the 442
pharmacy or pharmacist purchases the majority of prescription 443
drugs for resale, then the pharmacy benefit manager shall adjust 444
the maximum allowable cost as listed on the maximum allowable cost 445
list above the challenging pharmacy's pharmacy acquisition cost 446
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and permit the pharmacy to reverse and rebill each claim affected 447
by the inability to procure the drug at a cost that is equal to or 448
less than the previously challenged maximum allowable cost. 449
(e) The board may adopt rules and regulations necessary 450
to ensure compliance with this subsection. 451
(5) A pharmacy or pharmacist that belongs to a PSAO shall be 452
provided a true and correct copy of any contract and contract 453
amendment that the PSAO enters into with a pharmacy benefit 454
manager or third-party payer on the pharmacy's or pharmacist's 455
behalf. 456
(6) A pharmacy benefit manager shall not deny an appeal 457
submitted pursuant to subsection (4) of this section based upon an 458
existing contract with the pharmacy that provides for a 459
reimbursement rate lower than the pharmacy acquisition cost. 460
* * * 461
SECTION 5. Section 73-21-157, Mississippi Code of 1972, is 462
amended as follows: 463
73-21-157. (1) Before beginning to do business as a 464
pharmacy benefit manager or PSAO, a pharmacy benefit manager or 465
PSAO shall obtain a license to do business from the board. To 466
obtain a license, the applicant shall submit an application to the 467
board on a form to be prescribed by the board. This license shall 468
be renewed annually. 469
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(2) When applying for a license or renewal of a license, 470
each pharmacy benefit manager * * * or PSAO shall file * * * with 471
the board * * *: 472
(a) A copy of a certified audit report, if the pharmacy 473
benefit manager has been audited by a certified public accountant 474
within the last twenty-four (24) months; or 475
( * * *b) If the pharmacy benefit manager has not been 476
audited in the last twenty-four (24) months, a financial statement 477
of the organization, including its balance sheet and income 478
statement for the preceding year which shall be verified by at 479
least two (2) principal officers; and 480
( * * *c) Any other information relating to the 481
operations of the pharmacy benefit manager required by the 482
board * * *. 483
( * * *3) (a) Any information required to be submitted to 484
the board pursuant to licensure application that is considered 485
proprietary by a pharmacy benefit manager or PSAO shall be marked 486
as confidential when submitted to the board. All such information 487
shall not be subject to the provisions of the federal Freedom of 488
Information Act or the Mississippi Public Records Act and shall 489
not be released by the board unless subject to an order from a 490
court of competent jurisdiction. The board shall destroy or 491
delete or cause to be destroyed or deleted all such information 492
thirty (30) days after the board determines that the information 493
is no longer necessary or useful. 494
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(b) Any person who knowingly releases, causes to be 495
released or assists in the release of any such information shall 496
be subject to a monetary penalty imposed by the board in an amount 497
not exceeding Fifty Thousand Dollars ($50,000.00) per violation. 498
When the board is considering the imposition of any penalty under 499
this paragraph (b), it shall follow the same policies and 500
procedures provided for the imposition of other sanctions in the 501
Pharmacy Practice Act. Any penalty collected under this paragraph 502
(b) shall be deposited into the special fund of the board and used 503
to support the operations of the board relating to the regulation 504
of pharmacy benefit managers. 505
(c) All employees of the board who have access to the 506
information described in paragraph (a) of this subsection shall be 507
fingerprinted, and the board shall submit a set of fingerprints 508
for each employee to the Department of Public Safety for the 509
purpose of conducting a criminal history records check. If no 510
disqualifying record is identified at the state level, the 511
Department of Public Safety shall forward the fingerprints to the 512
Federal Bureau of Investigation for a national criminal history 513
records check. 514
( * * *4) * * * The board may waive the requirements for 515
filing financial information for the pharmacy benefit manager if 516
an affiliate of the pharmacy benefit manager is already required 517
to file such information under current law with the Commissioner 518
of Insurance and allow the pharmacy benefit manager to file a copy 519
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of documents containing such information with the board in lieu of 520
the statement required by this section. 521
( * * *5) The expense of administering this section shall be 522
assessed annually by the board against all pharmacy benefit 523
managers and PSAOs operating in this state. 524
( * * *6) A pharmacy benefit manager, PSAO or third-party 525
payor * * * shall not require pharmacy accreditation standards 526
or * * * certification requirements inconsistent with, more 527
stringent than, or in addition to federal and state requirements 528
for licensure as a pharmacy in this state. 529
SECTION 6. The following shall be codified as Section 530
73-21-158, Mississippi Code of 1972: 531
73-21-158. (1) A pharmacy benefit manager, PSAO, carrier or 532
health benefit plan may not, either directly or through an 533
intermediary, agent or affiliate, engage in, facilitate or enter 534
into a contract with another person involving spread pricing in 535
this state. 536
(2) A pharmacy benefit manager or PSAO contract with a 537
carrier or health benefit plan entered into, renewed or amended on 538
or after the effective date of this act must: 539
(a) Specify all forms of revenue, including pharmacy 540
benefit management or PSAO fees, to be paid by the carrier or 541
health benefit plan to the pharmacy benefit manager or PSAO; and 542
(b) Acknowledge that spread pricing is not permitted in 543
accordance with this section. 544
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(3) Subsections (1) and (2) of this section do not apply to 545
self-insured plans. 546
(4) Every pharmacy benefit manager and PSAO shall disclose 547
to the plan sponsor or employer one hundred percent (100%) of all 548
rebates and other payments that the pharmacy benefit manager or 549
PSAO receives directly or indirectly from pharmaceutical 550
manufacturers and/or rebate aggregators in connection with claims 551
administered on behalf of the plan sponsor or employer and the 552
recipients of those rebates. In addition, a pharmacy benefit 553
manager or PSAO shall report annually to each plan sponsor or 554
employer the aggregate amount of all rebates and other payments 555
and the recipients of such rebates unless the contract with the 556
plan sponsor or employer or the health benefit plan already 557
requires these disclosures. 558
(5) A pharmacy benefit manager or third-party payer may not 559
charge or cause a patient to pay an amount that exceeds the total 560
amount retained by the pharmacy. 561
SECTION 7. A pharmacy benefit manager may not reimburse a 562
pharmacy or pharmacist in the state an amount less than the amount 563
that the pharmacy benefit manager reimburses a pharmacy benefit 564
manager affiliate for providing the same drug or drugs. The 565
reimbursement amount for the drug or drugs must be calculated on a 566
per unit basis based on the same brand and generic product 567
identifier or brand and generic code number. However, this 568
section does not prohibit a pharmacy benefit manager or health 569
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plan from offering or applying a bona fide volume-based discount, 570
rebate or other price concession to an in-network pharmacy on 571
equal terms to all similarly situated in-network pharmacies, 572
including pharmacy benefit manager affiliate pharmacies, so long 573
as the arrangements: 574
(a) Are disclosed to the plan sponsor upon request; 575
(b) Are applied in a nondiscriminatory manner to all 576
pharmacies meeting the same participation criteria; and 577
(c) Comply with all applicable state and federal laws 578
regarding network adequacy and patient access. 579
SECTION 8. The following shall be codified as Section 580
73-21-162, Mississippi Code of 1972: 581
73-21-162. (1) Retaliation is prohibited. 582
(a) A pharmacy benefit manager, pharmacy benefit 583
manager affiliate or PSAO may not retaliate against a pharmacist 584
or pharmacy based on the pharmacist's or pharmacy's exercise of 585
any right or remedy under this chapter. Retaliation prohibited by 586
this section includes, but is not limited to: 587
(i) Terminating or refusing to renew a contract 588
with the pharmacist or pharmacy; 589
(ii) Subjecting the pharmacist or pharmacy to an 590
increased frequency of audits, number of claims audited or amount 591
of monies for claims audited; or 592
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(iii) Failing to promptly pay the pharmacist or 593
pharmacy any money owed by the pharmacy benefit manager to the 594
pharmacist or pharmacy. 595
(b) For the purposes of this section, a pharmacy 596
benefit manager, pharmacy benefit manager affiliate or PSAO is not 597
considered to have retaliated against a pharmacy if the pharmacy 598
benefit manager: 599
(i) Takes an action in response to a credible 600
allegation of fraud against the pharmacist or pharmacy; and 601
(ii) Provides reasonable notice to the pharmacist 602
or pharmacy of the allegation of fraud and the basis of the 603
allegation before initiating an action. 604
(2) A pharmacy benefit manager, pharmacy benefit manager 605
affiliate or PSAO may not penalize or retaliate against a 606
pharmacist, pharmacy or pharmacy employee for exercising rights 607
under this chapter, initiating a judicial or regulatory action or 608
discussing or disclosing information pertaining to an agreement 609
with a pharmacy benefit manager or a pharmacy benefit manager 610
affiliate when testifying or otherwise appearing before a 611
governmental agency, legislative member or body or a judicial 612
authority. 613
SECTION 9. Section 73-21-163, Mississippi Code of 1972, is 614
amended as follows: 615
73-21-163. (1) Whenever the board has reason to believe 616
that a pharmacy benefit manager * * *, pharmacy benefit manager 617
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affiliate or PSAO is using, has used, or is about to use any 618
method, act or practice prohibited in * * * this act and that 619
proceedings would be in the public interest, it may bring an 620
action in the name of the board against the pharmacy benefit 621
manager * * *, pharmacy benefit manager affiliate or PSAO to 622
restrain by temporary or permanent injunction the use of such 623
method, act or practice. The action shall be brought in the 624
Chancery Court of the First Judicial District of Hinds County, 625
Mississippi. The court is authorized to issue temporary or 626
permanent injunctions to restrain and prevent violations of * * * 627
this act and such injunctions shall be issued without bond. 628
(2) The board may impose a monetary penalty on a pharmacy 629
benefit manager * * *, a pharmacy benefit manager affiliate or 630
PSAO for noncompliance with the provisions of * * * this act, in 631
amounts of not less than One Thousand Dollars ($1,000.00) per 632
violation and not more than Twenty-five Thousand Dollars 633
($25,000.00) per violation. Each day a violation continues for 634
the same brand or generic product identifier or brand or generic 635
code number is a separate violation. Each day that a pharmacy 636
benefit manager or PSAO does business in this state without a 637
license is deemed a separate violation. The board shall prepare a 638
record entered upon its minutes that states the basic facts upon 639
which the monetary penalty was imposed. Any penalty collected 640
under this subsection (2) shall be deposited into the special fund 641
of the board. 642
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(3) For the purposes of conducting investigations, the 643
board, through its executive director, may conduct audits and 644
examinations of a pharmacy benefit manager or PSAO and may also 645
issue subpoenas to a pharmacy, pharmacy benefit manager or PSAO 646
having documents or records that it deems relevant to the 647
investigation. 648
( * * *4) The board may assess a monetary penalty for those 649
reasonable costs that are expended by the board in the 650
investigation and conduct of a proceeding if the board imposes a 651
monetary penalty under subsection (2) of this section. A monetary 652
penalty assessed and levied under this section shall be paid to 653
the board by the licensee, registrant or permit holder upon the 654
expiration of the period allowed for appeal of those penalties 655
under Section 73-21-101, or may be paid sooner if the licensee, 656
registrant or permit holder elects. Any penalty collected by the 657
board under this subsection ( * * *4) shall be deposited into the 658
special fund of the board. 659
( * * *5) When payment of a monetary penalty assessed and 660
levied by the board against a licensee, registrant or permit 661
holder in accordance with this section is not paid by the 662
licensee, registrant or permit holder when due under this section, 663
the board shall have the power to institute and maintain 664
proceedings in its name for enforcement of payment in the chancery 665
court of the county and judicial district of residence of the 666
licensee, registrant or permit holder, or if the licensee, 667
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registrant or permit holder is a nonresident of the State of 668
Mississippi, in the Chancery Court of the First Judicial District 669
of Hinds County, Mississippi. When those proceedings are 670
instituted, the board shall certify the record of its proceedings, 671
together with all documents and evidence, to the chancery court 672
and the matter shall be heard in due course by the court, which 673
shall review the record and make its determination thereon in 674
accordance with the provisions of Section 73-21-101. The hearing 675
on the matter may, in the discretion of the chancellor, be tried 676
in vacation. 677
(6) (a) The board may conduct audits to ensure compliance 678
with the provisions of this act. In conducting audits, the board 679
may request production of documents pertaining to compliance with 680
the provisions of this act, and documents so requested must be 681
produced within thirty (30) days of the request unless extended by 682
the board or its duly authorized staff. 683
(b) If, after the conclusion of the audit, the pharmacy 684
benefit manager or PSAO was found to be in compliance with all of 685
the requirements of this act, then the board shall pay the costs 686
of the audit. However, the pharmacy benefit manager or PSAO being 687
audited shall pay all costs of the audit if the audit reveals 688
noncompliance with this act. The cost of the audit examination 689
must be deposited into the special fund and used by the board, 690
upon appropriation of the Legislature, to support the operations 691
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of the board relating to the regulation of pharmacy benefit 692
managers. 693
(c) The board may hire independent consultants to 694
conduct audits of a pharmacy benefit manager and expend funds 695
collected under this section to pay the cost of performing audit 696
services. 697
( * * *7) The board shall develop and implement a uniform 698
penalty policy that sets the minimum and maximum penalty for any 699
given violation of * * * this act. The board shall adhere to its 700
uniform penalty policy except in those cases where the board 701
specifically finds, by majority vote, that a penalty in excess of, 702
or less than, the uniform penalty is appropriate. That vote shall 703
be reflected in the minutes of the board and shall not be imposed 704
unless it appears as having been adopted by the board. 705
SECTION 10. The following shall be codified as Section 706
73-21-165, Mississippi Code of 1972: 707
73-21-165. (1) Each drug manufacturer shall submit a report 708
to the board annually no later than the fifteenth day of October 709
with the current wholesale acquisition cost information for the 710
prescription drugs sold in or into the state by that drug 711
manufacturer; however, the first report due under this subsection 712
shall not be due until October 1, 2027. 713
(2) Not more than thirty (30) days after an increase in 714
wholesale acquisition cost of forty percent (40%) or greater over 715
the preceding three (3) calendar years or fifteen percent (15%) or 716
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greater in the preceding twelve (12) months for a prescription 717
drug with a wholesale acquisition cost of One Hundred Dollars 718
($100.00) or more for a 30-day supply, a drug manufacturer shall 719
submit a report to the board. The report must contain the 720
following information: 721
(a) The name of the drug; 722
(b) Whether the drug is a brand name or a generic; 723
(c) The effective date of the change in wholesale 724
acquisition cost; 725
(d) Aggregate, company-level research and development 726
costs for the previous calendar year; 727
(e) Aggregate rebate amounts paid to each pharmacy 728
benefit manager or PSAO for the previous calendar year; 729
(f) The name of each of the drug manufacturer's drugs 730
approved by the United States Food and Drug Administration in the 731
previous three (3) calendar years; 732
(g) The name of each of the drug manufacturer's drugs 733
that lost patent exclusivity in the United States in the previous 734
three (3) calendar years; and 735
(h) A concise statement of rationale regarding the 736
factor or factors that caused the increase in the wholesale 737
acquisition cost, such as raw ingredient shortage or increase in 738
pharmacy benefit manager's or PSAO's rebates. 739
(3) A manufacturer's obligations under this section are 740
fully satisfied by the submission of any information and data that 741
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a manufacturer includes in the manufacturer's annual consolidated 742
report on Securities and Exchange Form 10-K or any other public 743
disclosure. A drug manufacturer shall notify the board in writing 744
if the drug manufacturer is introducing a new prescription drug to 745
market at a wholesale acquisition cost that exceeds the threshold 746
set for a specialty drug under the Medicare Part D Program. 747
(4) The notice must include a concise statement of rationale 748
regarding the factor or factors that caused the new drug to exceed 749
the Medicare Part D Program price. The drug manufacturer shall 750
provide the written notice within three (3) calendar days 751
following the release of the drug in the commercial market. A 752
drug manufacturer may make the notification pending approval by 753
the United States Food and Drug Administration if commercial 754
availability is expected within three (3) calendar days following 755
the approval. 756
(5) On or before October 1st of each year, a pharmacy 757
benefit manager or PSAO providing services for a health care plan 758
shall file a report with the board. The report must contain the 759
following information for the previous state fiscal year: 760
(a) The aggregated rebates, fees, price protection 761
payments, and any other payments collected from each drug 762
manufacturer; 763
(b) The aggregated dollar amount of rebates, price 764
protection payments, fees, and any other payments collected from 765
each drug manufacturer which were passed to health insurers; 766
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(c) The aggregated fees, price concessions, penalties, 767
effective rates, and any other financial incentive collected from 768
pharmacies which were passed to enrollees at the point of sale; 769
(d) The aggregated dollar amount of rebates, price 770
protection payments, fees, and any other payments collected from 771
drug manufacturers which were retained as revenue by the pharmacy 772
benefit manager or PSAO; and 773
(e) The aggregated rebates passed on to employers. 774
(6) Reports submitted by pharmacy benefit managers and PSAOs 775
under this section may not disclose the identity of a specific 776
health benefit plan or enrollee, the identity of a drug 777
manufacturer, the prices charged for specific drugs or classes of 778
drugs, or the amount of any rebates or fees provided for specific 779
drugs or classes of drugs. 780
(7) On or before October 1st of each year, each health 781
insurer shall submit a report to the board. The report must 782
contain the following information for the previous two (2) 783
calendar years: 784
(a) Names of the twenty-five (25) most frequently 785
prescribed drugs across all plans; 786
(b) Names of the twenty-five (25) prescription drugs 787
dispensed with the highest dollar spent in terms of gross revenue; 788
(c) Percent of increase in annual net spending for 789
prescription drugs across all plans; 790
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(d) Percent of increase in premiums which is 791
attributable to prescription drugs across all plans; 792
(e) Percentage of specialty drugs with utilization 793
management requirements across all plans; and 794
(f) Premium reductions attributable to specialty drug 795
utilization management. 796
(8) A report submitted by a health insurer may not disclose 797
the identity of a specific health benefit plan or the prices 798
charged for specific prescription drugs or classes of prescription 799
drugs. 800
SECTION 11. The following shall be codified as Section 801
73-21-167, Mississippi Code of 1972: 802
73-21-167. (1) The board shall develop a website to publish 803
information the board receives under this chapter. The board 804
shall make the website available on the board's website with a 805
dedicated link prominently displayed on the home page, or by a 806
separate, easily identifiable Internet address. 807
(2) Within sixty (60) days of receipt of reported 808
information under this chapter, the board shall publish the 809
reported information on the website developed under this section. 810
The information the board publishes may not disclose or tend to 811
disclose trade secrets, proprietary, commercial, financial or 812
confidential information of any pharmacy, pharmacy benefit 813
manager, PSAO, drug wholesaler, drug manufacturer or hospital. 814
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(3) The board may adopt rules to implement this chapter. 815
The board shall develop forms that must be used for reporting 816
required under this chapter. The board may contract for services 817
to implement this chapter. 818
(4) A report received by the board is not subject to the 819
provisions of the federal Freedom of Information Act or the 820
Mississippi Public Records Act and may not be released by the 821
board unless subject to an order from a court of competent 822
jurisdiction. The board shall destroy or delete or cause to be 823
destroyed or deleted all such information thirty (30) days after 824
the board determines that the information is no longer necessary 825
or useful. 826
SECTION 12. The following shall be codified as Section 827
73-21-169, Mississippi Code of 1972: 828
73-21-169. (1) Pharmacy benefit managers and PSAOs shall 829
identify to the board any ownership affiliation of any kind with 830
any pharmacy which, either directly or indirectly, through 831
one or more intermediaries: 832
(a) Has an investment or ownership interest in a 833
pharmacy benefit manager or PSAO holding a certificate of 834
authority; 835
(b) Shares common ownership with a pharmacy benefit 836
manager or PSAO holding a certificate of authority in this state; 837
or 838
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(c) Has an investor or a holder of an ownership 839
interest which is a pharmacy benefit manager or PSAO holding a 840
certificate of authority issued in this state. 841
(2) A pharmacy benefit manager or PSAO shall report any 842
change in information required by this act to the board in writing 843
within sixty (60) days after the change occurs. 844
SECTION 13. (1) There is created the Mississippi 845
Independent Pharmacist Reimbursement Assistance Grant Program to 846
be administered by the State Board of Pharmacy. The purpose of 847
the program is to provide financial assistance to independent 848
community pharmacies located in Mississippi which experience 849
sustained reimbursement pressures, increased operational costs, or 850
other economic challenges that threaten continued access to 851
pharmacy services in underserved areas. 852
(2) For purposes of this section, the following words and 853
phrases have the meanings provided in this subsection unless the 854
context clearly requires otherwise: 855
(a) "Board" means the State Board of Pharmacy. 856
(b) "Eligible costs" includes, but is not limited to, 857
reimbursement shortfalls, staffing expenses, technology upgrades, 858
patient care services, workflow modernization, rural delivery 859
expansion, inventory carrying costs, and other expenses approved 860
by the board. 861
(c) "Independent pharmacy" means a pharmacy licensed by 862
the State Board of Pharmacy which is privately owned, has fewer 863
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than five (5) locations under common ownership, and is not owned, 864
controlled or affiliated with a pharmacy benefit manager, health 865
insurer, chain pharmacy or publicly traded corporation. 866
(3) An independent pharmacy may apply for reimbursement 867
assistance under this section if it: 868
(a) Maintains active licensure in good standing with 869
the board; 870
(b) Has operated in Mississippi for at least twelve 871
(12) consecutive months before application; 872
(c) Demonstrates financial hardship or reimbursement 873
inadequacy through documentation required by the board; and 874
(d) Provides pharmacy services to Medicaid 875
beneficiaries, Medicare beneficiaries or patients in rural or 876
medically underserved areas, as defined by the board. 877
(4) (a) Subject to available funding, the board may award 878
grants on an annual basis. 879
(b) An eligible pharmacy may receive up to an amount 880
established annually by the board, based on available 881
appropriations. 882
(c) Grants may be prorated among eligible applicants if 883
requests exceed available funds. 884
(d) Grant funds may not be used to replace or duplicate 885
funding provided by federal programs or private settlements but 886
may supplement such funds. 887
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(5) (a) The board shall establish an application process, 888
required documentation, timelines and evaluation standards. 889
(b) The board shall consider factors such as financial 890
hardship, geographic access needs, patient volume, and the 891
availability of pharmacy services in the applicant’s community. 892
(c) The board may require reporting on how grant funds 893
are used and may audit recipients to ensure compliance. 894
(6) The board shall promulgate rules and regulations 895
necessary to implement and administer the program, including 896
application criteria, award methodologies, documentation 897
requirements, allowable uses, reporting obligations, and 898
enforcement provisions. 899
(7) (a) The program shall be funded through annual 900
appropriations by the Legislature, grants, donations or other 901
funds made available to the board for this purpose. 902
(b) Grant funds must be deposited into a special fund 903
created in the State Treasury known as the "Independent Pharmacist 904
Reimbursement Assistance Grant Fund," which may be used solely for 905
administering and awarding grants under this section. 906
(c) The fund shall be subject to appropriation by the 907
Legislature. 908
(8) The board shall submit an annual report to the chairs of 909
the Senate Public Health and Welfare and the House Public Health 910
and Human Services Committees, detailing program participation, 911
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ST: Pharmacy Benefit Prompt Act; revise.
geographic distribution of awards, financial data and the impact 912
of the program on pharmacy access in Mississippi. 913
SECTION 14. (1) This act may not be construed to: 914
(a) Impose a fiduciary duty on a pharmacy benefit 915
manager or health insurer which is inconsistent with federal law; 916
(b) Prohibit pharmacy benefit managers or health plans 917
from designing formularies, benefit tiers or networks that manage 918
cost and utilization, provided such design complies with existing 919
state and federal law; 920
(c) Limit the ability of pharmacy benefit managers to 921
negotiate volume-based discounts or rebates, including with 922
affiliated pharmacies, so long as the arrangements are disclosed 923
and in compliance with Section 7 of this act; or 924
(d) Require a health benefit plan or plan sponsor to 925
include all willing pharmacies in its preferred network if the 926
inclusion would undermine cost control mechanisms, provided the 927
network remains accessible in accordance with Section 83-9-6. 928
SECTION 15. This act shall take effect and be in force from 929
and after July 1, 2026. 930