Pharmacy Benefit Prompt Pay Act; revise.

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To: State Affairs
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representatives Scoggin, Nelson, Shanks

HOUSE BILL NO. 1672

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
AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO REVISE THE 6
REIMBURSEMENT AMOUNT FROM PHARMACY BENEFIT MANAGERS AND PHARMACY 7
SERVICES ADMINISTRATIVE ORGANIZATIONS (PSAOS) PAYABLE TO 8
PHARMACIES; TO REQUIRE PHARMACY BENEFIT MANAGERS TO GIVE 9
PHARMACISTS REASONS FOR DENYING A CLAIM WITHIN SEVEN DAYS OF 10
RECEIVING AN ELECTRONIC CLAIM; TO AMEND SECTION 73-21-156, 11
MISSISSIPPI CODE OF 1972, TO DELETE PROVISIONS AUTHORIZING 12
PHARMACY BENEFIT MANAGERS FROM USING MAXIMUM ALLOWABLE COST LISTS; 13
TO REVISE THE ADMINISTRATIVE APPEALS PROCESS PHARMACY BENEFIT 14
MANAGERS MUST MAKE AVAILABLE TO PHARMACIES TO CHALLENGE 15
REIMBURSEMENTS; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 16
1972, TO REQUIRE PSAOS TO BE LICENSED BY THE STATE BOARD OF 17
PHARMACY; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO RENEW 18
LICENSES ANNUALLY; TO REVISE THE FINANCIAL DOCUMENTS THAT MUST BE 19
SUBMITTED TO THE BOARD WITH AN APPLICATION FOR A LICENSE OR 20
LICENSE RENEWAL; TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE 21
OF 1972, TO PROHIBIT THE USE OF SPREAD PRICING BY PHARMACY BENEFIT 22
MANAGERS; TO BRING FORWARD SECTION 73-21-159, MISSISSIPPI CODE OF 23
1972, WHICH RELATES TO FINANCIAL EXAMINATIONS OF PHARMACY BENEFIT 24
MANAGERS, FOR PURPOSES OF POSSIBLE AMENDMENT; TO AMEND SECTION 25
73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT STEERING BY 26
PHARMACY BENEFIT MANAGERS; TO CREATE NEW SECTION 73-21-162, 27
MISSISSIPPI CODE OF 1972, TO PROHIBIT RETALIATION AGAINST 28
PHARMACISTS BY PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER 29
AFFILIATES AND PSAOS; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE 30
OF 1972, TO REVISE PROVISIONS RELATING TO INVESTIGATIONS AND 31
AUDITS OF PHARMACY BENEFIT MANAGERS CONDUCTED BY THE BOARD; TO 32
CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE 33
PHARMACY BENEFIT MANAGERS TO SUBMIT CERTAIN ANNUAL REPORTS TO THE 34
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BOARD; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, 35
TO CREATE THE MISSISSIPPI SPECIALTY DRUG COMMITTEE; TO CREATE NEW 36
SECTION 73-21-211, MISSISSIPPI CODE OF 1972, TO DESIGNATE CERTAIN 37
NEWLY CREATED STATUTES AS THE PHARMACY FAIR COMPETITION ACT; TO 38
CREATE NEW SECTION 73-21-213, MISSISSIPPI CODE OF 1972, TO DECLARE 39
CERTAIN LEGISLATIVE FINDINGS RELATING TO THE DISTRIBUTION AND 40
RETAIL SALE OF PHARMACEUTICAL DRUGS AND THE PUBLIC NECESSITY TO 41
REGULATE AND LICENSE CERTAIN PHARMACEUTICAL INDUSTRIES; TO CREATE 42
NEW SECTION 73-15-215, MISSISSIPPI CODE OF 1972, TO PROHIBIT 43
PHARMACY BENEFIT MANAGERS FROM HOLDING A PHARMACY PERMIT FOR THE 44
RETAIL SALE OF DRUGS; TO AUTHORIZE THE BOARD TO ISSUE LIMITED USE 45
PERMITS FOR THE SALE OF RARE DRUGS UNDER CERTAIN CIRCUMSTANCES; TO 46
CREATE NEW SECTION 73-21-217, MISSISSIPPI CODE OF 1972, TO REQUIRE 47
THE BOARD TO ASSESS EACH ACTIVE RETAIL PHARMACY PERMIT TO 48
DETERMINE IF THE PERMIT HOLDER IS IN VIOLATION OF SECTION 49
73-21-215, MISSISSIPPI CODE OF 1972; TO AMEND SECTION 25-15-301, 50
MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE STATE AND SCHOOL 51
EMPLOYEES LIFE AND HEALTH INSURANCE PLAN TO CONTRACT FOR THE 52
MANAGEMENT OF PHARMACY BENEFITS; TO REQUIRE THE EXECUTIVE DIRECTOR 53
OF THE STATE BOARD OF PHARMACY TO BE A MEMBER OF THE EVALUATION 54
COMMITTEE WHEN CONSIDERING PROPOSALS FOR SUCH ADMINISTRATION; TO 55
REQUIRE A PHARMACY BENEFITS MANAGER FOR THE STATE HEALTH PLAN TO 56
COMPLY WITH THE PROVISIONS OF THE PHARMACY BENEFIT PROMPT PAY ACT; 57
TO AMEND SECTION 25-15-303, MISSISSIPPI CODE OF 1972, TO ADD THE 58
EXECUTIVE DIRECTOR OF THE STATE BOARD OF PHARMACY TO THE 59
MEMBERSHIP OF THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE 60
MANAGEMENT BOARD; AND FOR RELATED PURPOSES. 61
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 62
SECTION 1. Section 73-21-151, Mississippi Code of 1972, is 63
amended as follows: 64
73-21-151. Sections 73-21-151 through * * * 73-21-167 shall 65
be known as the "Pharmacy Benefit Prompt Pay Act." 66
SECTION 2. Section 73-21-153, Mississippi Code of 1972, is 67
amended as follows: 68
73-21-153. For purposes of Sections 73-21-151 through * * * 69
73-21-167, the following words and phrases shall have the meanings 70
ascribed herein unless the context clearly indicates otherwise: 71
(a) "Board" means the State Board of Pharmacy. 72
(b) "Clean claim" means a completed billing instrument, 73
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paper or electronic, received by a pharmacy benefit manager from a 74
pharmacist or pharmacies or the insured, which is accepted and 75
payment remittance advice is provided by the pharmacy benefit 76
manager. The term "clean claim" includes resubmitted claims with 77
previously identified deficiencies corrected. 78
(c) "Commissioner" means the Mississippi Commissioner 79
of Insurance. 80
( * * *d) "Day" means a calendar day, unless otherwise 81
defined or limited. 82
(e) "Drug" has the same definition as provided in 83
Section 73-21-73. 84
( * * *f) "Electronic claim" means the transmission of 85
data for purposes of payment of covered prescription drugs, other 86
products and supplies, and pharmacist services in an electronic 87
data format specified by a pharmacy benefit manager and approved 88
by the department. 89
( * * *g) "Electronic adjudication" means the process 90
of electronically receiving * * * and reviewing an electronic 91
claim and either accepting and providing payment remittance advice 92
for the electronic claim or rejecting * * * the electronic claim. 93
( * * *h) "Enrollee" means an individual who has been 94
enrolled in a pharmacy benefit management plan or health insurance 95
plan. 96
( * * *i) "Health insurance plan" means benefits 97
consisting of prescription drugs, other products and supplies, and 98
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pharmacist services provided directly, through insurance or 99
reimbursement, or otherwise and including items and services paid 100
for as prescription drugs, other products and supplies, and 101
pharmacist services under any hospital or medical service policy 102
or certificate, hospital or medical service plan contract, 103
preferred provider organization agreement, or health maintenance 104
organization contract offered by a health insurance issuer. 105
(j) "Network pharmacy" means a pharmacy licensed by the 106
board which provides pharmacy services to Mississippi consumers 107
and has a contract with a pharmacy benefit manager to provide 108
covered drugs at a negotiated reimbursement rate. 109
(k) "Payment remittance advice" means the claim detail 110
that the pharmacy receives when successfully processing an 111
electronic or paper claim. The claim detail must contain, but is 112
not limited to: 113
(i) The amount that the pharmacy benefit manager 114
or PSAO will reimburse for product ingredient; and 115
(ii) The amount that the pharmacy benefit manager 116
or PSAO will reimburse for product dispensing fee; and 117
(iii) The amount that the pharmacy benefit manager 118
or health insurance plan dictates the patient must pay. 119
(l) "Pharmacist" has the same definition as provided in 120
Section 73-21-73. 121
(m) "Pharmacy" has the same definition as provided in 122
Section 73-21-73. 123
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(n) "Pharmacy acquisition cost" means the amount that a 124
pharmaceutical wholesaler charges for a pharmaceutical product as 125
listed on the pharmacy's billing invoice. 126
( * * *o) "Pharmacy benefit manager" * * * means an 127
entity that provides pharmacy benefit management services. The 128
term "pharmacy benefit manager" shall not include: 129
(i) An insurance company unless the insurance 130
company is providing services as a pharmacy benefit manager * * *, 131
in which case the insurance company shall be subject to * * * this 132
act only for those pharmacy benefit manager services * * *; or 133
(ii) The Mississippi Division of Medicaid or its 134
contractors when performing pharmacy benefit manager services for 135
the Division of Medicaid. 136
( * * *p) "Pharmacy benefit manager affiliate" 137
means * * * an entity that, directly or indirectly, * * * owns or 138
controls, is owned or controlled by, or is under common ownership 139
or control with a pharmacy benefit manager. 140
( * * *q) "Pharmacy benefit management plan" * * * 141
means an arrangement for the delivery of pharmacist's services in 142
which a pharmacy benefit manager undertakes to administer the 143
payment or reimbursement of any of the costs of pharmacist's 144
services, drugs or devices. 145
(r) "Pharmacy benefit management services" includes, 146
but is not limited to, the following services, which may be 147
provided either directly or through outsourcing or contracts: 148
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(i) Adjudicate drug claims or any portion of the 149
transaction; 150
(ii) Contract with retail and mail pharmacy 151
networks; 152
(iii) Establish payment levels for pharmacies; 153
(iv) Develop formularies or drug lists of covered 154
therapies; 155
(v) Provide benefit design consultation; 156
(vi) Manage cost and utilization trends; 157
(vii) Contract for manufacturer rebates; 158
(viii) Provide fee-based clinical services to 159
improve member care; 160
(ix) Third-party administration; and 161
(x) Sponsoring or providing cash discount cards, 162
as defined in Section 83-9-6.1, and electronic discount cards. 163
(s) "Pharmacist services" means products, goods and 164
services, or any combination of products, goods and services, 165
provided as part of the practice of pharmacy. 166
(t) "Pharmacy services administrative organization" or 167
"PSAO" means an entity that contracts with a pharmacy or 168
pharmacist to assist with third-party payer interactions and which 169
may provide a variety of other administrative services, including, 170
but not limited to, contracting with third-party payers or 171
pharmacy benefit managers on behalf of pharmacies and providing 172
pharmacies or pharmacists with credentialing, billing, audit, 173
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general business and analytic support. A covered entity, as 174
defined in 42 USC Section 256b, including its pharmacy or the 175
transactions related to the 340B drug discount program of a 176
pharmacy contracted with the participating covered entity to 177
dispense drugs purchased through the 340B drug discount program, 178
is not considered to be a pharmacy services administrative 179
organization. 180
(u) "Plan sponsors" means the employers, insurance 181
companies, unions and health maintenance organizations that 182
contract, either directly or indirectly, with a pharmacy benefit 183
manager for delivery of prescription drugs or services, or both. 184
(v) "Proprietary information" means information on 185
pricing, costs, revenue, taxes, market share, negotiating 186
strategies, customers and personnel that is held by a pharmacy 187
benefit manager or PSAO and used for its business purposes. 188
(w) "Rebate" means any and all payments and price 189
concessions that accrue to a pharmacy benefit manager or its plan 190
sponsor client, directly or indirectly, including through an 191
affiliate, subsidiary, third party or intermediary, including 192
off-shore group purchasing organizations, from a pharmaceutical 193
manufacturer, its affiliate, subsidiary, third party or 194
intermediary, including, but not limited to, payments, discounts, 195
administration fees, credits, incentives, price concessions or 196
penalties associated, directly or indirectly, in any way with 197
claims administered on behalf of a plan sponsor. 198
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(x) "Spread pricing" means an amount charged or claimed 199
by a pharmacy benefit manager or PSAO in excess of the ingredient 200
cost for a dispensed prescription drug plus dispensing fee paid 201
directly or indirectly to a pharmacy, pharmacist or other provider 202
on behalf of the health benefit plan. 203
* * * 204
( * * *y) "Uniform claim form" means a form prescribed 205
by rule by the * * * board; however, for purposes of * * * this 206
act, the board shall adopt the same definition or rule where the 207
State Department of Insurance has adopted a rule covering the same 208
type of claim. The board may modify the terminology of the rule 209
and form when necessary to comply with the provisions of * * * 210
this act. 211
(z) "Wholesale acquisition cost" means the wholesale 212
acquisition cost of the drug as defined in 42 USC Section 213
1395w-3a(c)(6)(B). 214
* * * 215
SECTION 3. Section 73-21-155, Mississippi Code of 1972, is 216
amended as follows: 217
73-21-155. (1) Reimbursement * * * to a pharmacist or 218
pharmacy by a pharmacy benefit manager or PSAO for the dispensing 219
of a prescription drug * * * and other products and supplies * * * 220
shall be a net amount not less than the greater of: 221
(a) The total reimbursement paid to its pharmacy 222
benefit manager affiliate; or 223
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(b) The total reimbursement paid by the Mississippi 224
Division of Medicaid in its pharmacy reimbursement methodology. 225
(2) * * * (a) All benefits payable * * * from a pharmacy 226
benefit * * * manager or PSAO shall be paid within seven (7) days 227
after receipt of * * * a clean electronic claim where * * * the 228
claim was electronically adjudicated, and shall be paid within 229
thirty-five (35) days after receipt of due written proof of a 230
clean claim where claims are submitted in paper format. 231
Benefits * * * are overdue if not paid within seven (7) days or 232
thirty-five (35) days, whichever is applicable, after the pharmacy 233
benefit manager receives a clean claim containing necessary 234
information essential for the pharmacy benefit manager to 235
administer preexisting condition, coordination of benefits and 236
subrogation provisions under the plan sponsor's * * * plan. * * * 237
* * * 238
( * * *b) * * * If an electronic claim is denied, the 239
pharmacy benefit manager shall * * * notify the pharmacist or 240
pharmacy * * * within seven (7) days of the reasons why the claim 241
or portion thereof is not clean and will not be paid and what 242
substantiating documentation and information is required to 243
adjudicate the claim as clean. * * * If a written claim is 244
denied, the pharmacy benefit manager shall notify the pharmacy or 245
pharmacies no later than thirty-five (35) days * * * of receipt of 246
the claim * * *. The pharmacy benefit manager shall * * * notify 247
the pharmacist or pharmacy * * * of the reasons why the claim or 248
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portion thereof is not clean and will not be paid and what 249
substantiating documentation and information is required to 250
adjudicate the claim as clean. Any claim or portion thereof 251
resubmitted with the supporting documentation and information 252
requested by the pharmacy benefit manager shall be paid within 253
twenty (20) days after receipt. 254
( * * *3) If the board finds that any pharmacy benefit 255
manager, PSAO, agent or other party responsible for reimbursement 256
for prescription drugs and other products and supplies has not 257
paid ninety-five percent (95%) of clean claims, as defined 258
in * * * Section 73-21-153, received from all pharmacies in a 259
calendar quarter, * * * the pharmacy benefit manager, PSAO, agent 260
or other party shall be subject to an administrative penalty of 261
not more than Twenty-five Thousand Dollars ($25,000.00) to be 262
assessed by the State Board of Pharmacy. 263
(a) Examinations to determine compliance with 264
this * * * section may be conducted by the board. The board may 265
contract with qualified impartial outside sources to assist in 266
examinations to determine compliance. * * * 267
(b) Nothing in the provisions of this section shall 268
require a pharmacy benefit manager to pay claims that are not 269
covered under the terms of a contract * * *, plan, policy of 270
accident and sickness insurance or prepaid coverage. 271
* * * 272
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( * * *c) Any pharmacy benefit manager * * * may enter 273
into an express written agreement * * * with a pharmacy or PSAO on 274
behalf of a pharmacy that contains timely claim payment provisions 275
which differ from, but are at least as stringent as, the 276
provisions set forth under subsection ( * * *2) of this section, 277
and in such case, the provisions of the written agreement shall 278
govern the timely payment of claims by the pharmacy benefit 279
manager or PSAO to the pharmacy. If the express written agreement 280
is silent as to any interest penalty where claims are not paid in 281
accordance with the agreement, the interest penalty provision of 282
subsection (4) * * * of this section shall apply. 283
( * * *d) The State Board of Pharmacy may adopt rules 284
and regulations necessary to ensure compliance with this 285
subsection. 286
( * * *4) If a clean claim is not paid or is denied without 287
providing to the pharmacy a valid and proper reason as to why the 288
claim is not clean by the end of the applicable time period 289
prescribed in this section, the pharmacy benefit manager must pay 290
the pharmacy (when the claim is owed to the pharmacy) or the 291
patient (when the claim is owed to a patient) interest on accrued 292
benefits at the rate of one and one-half percent (1-1/2%) per 293
month accruing from the day after payment was due on the amount of 294
the benefits that remain unpaid until the claim is finally settled 295
or adjudicated. Whenever interest due pursuant to this subsection 296
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is less than One Dollar ($1.00), such amount shall be credited to 297
the account of the person or entity to whom such amount is owed. 298
(5) (a) * * * A network pharmacy or pharmacist may decline 299
to provide a brand name drug, * * * generic drug, biosimilar drug 300
or service, if the network pharmacy or pharmacist is paid less 301
than that network pharmacy's acquisition cost for the * * * 302
prescription. If the network pharmacy or pharmacist declines to 303
provide such drug or service, the pharmacy or pharmacist shall 304
provide the customer with adequate information as to where the 305
prescription for the drug or service may be filled. A pharmacy 306
benefit manager may not require a pharmacy or pharmacist to submit 307
a claim for payment through a plan of the patient when the patient 308
requests to pay for the prescription drug with cash or an 309
alternative payment method. 310
(b) The State Board of Pharmacy shall adopt rules and 311
regulations necessary to implement and ensure compliance with this 312
subsection, including, but not limited to, rules and regulations 313
that address access to pharmacy services in rural or underserved 314
areas and also in cases where a network pharmacy or pharmacist 315
declines to provide a drug or service under paragraph (a) of this 316
subsection. * * * 317
(6) A pharmacy benefit manager or PSAO shall not directly or 318
indirectly retroactively deny or reduce a claim or aggregate of 319
claims after the claim or aggregate of claims has been 320
adjudicated. 321
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(7) A pharmacy benefit manager or PSAO may not impose a fee 322
or otherwise adjust or lower the reimbursement of a claim at the 323
time the claim is adjudicated, or after the claim is adjudicated, 324
which reduces the amount of the reimbursement for the claim. 325
SECTION 4. Section 73-21-156, Mississippi Code of 1972, is 326
amended as follows: 327
73-21-156. (1) * * * A pharmacy benefit manager shall: 328
(a) Provide a reasonable administrative appeal 329
procedure to allow pharmacies to challenge * * * reimbursements 330
made * * * for a specific drug or drugs as: 331
(i) Not meeting the requirements of this 332
section; * * * 333
(ii) Being below the pharmacy acquisition 334
cost * * *; or 335
(iii) Being below the reimbursement rate required 336
under subsection (1) of Section 173-51-155. 337
(b) The reasonable administrative appeal procedure 338
shall include the following: 339
(i) A * * *telephone number * * * and email 340
address * * * on the main page of the website of the pharmacy 341
benefit manager which provides direct access to the claim appeals 342
department; 343
(ii) The pharmacy benefit manager shall provide a 344
detailed written response within seven (7) days of receipt of an 345
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email or telephone call from a pharmacist or pharmacy regarding an 346
issue with an administrative appeal; 347
(iii) The website of the pharmacy benefit manager 348
must include easily accessible administrative appeal instructions 349
and list any other required information to be submitted by 350
pharmacies for the purpose of submitting administrative appeals; 351
(iv) The ability to submit * * * a single 352
administrative appeal or a claim appeal report for multiple claims 353
directly to the pharmacy benefit manager * * * or through a * * * 354
PSAO; and 355
( * * *v) A period of no less than thirty 356
(30) * * * days to file an administrative appeal. 357
(c) The pharmacy benefit manager shall respond to the 358
challenge under * * * this subsection * * * within thirty 359
(30) * * * days after receipt of the challenge. 360
(d) If a challenge is made under * * * this 361
subsection * * *, the pharmacy benefit manager shall, within 362
thirty (30) * * * days after receipt of the challenge, either: 363
(i) * * * Uphold the appeal * * * and: 364
1. * * * Adjust the reimbursement or 365
reimbursements paid to the pharmacist or pharmacy to the greater 366
of either the pharmacy acquisition cost or the amount required 367
under subsection (1) of Section 73-21-155; and 368
2. Permit the challenging pharmacy or 369
pharmacist to reverse and rebill the claim in question; and 370
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* * * 371
* * *3. Make the * * * adjustment for that 372
National Drug Code effective for * * * the pharmacy * * * that 373
filed the claim for a time period of no less than ninety (90) days 374
from the date the claim appeal was upheld; or 375
(ii) * * * Deny the appeal * * * and provide the 376
reason for the denial in writing to the challenging pharmacy or 377
pharmacist * * *. 378
(e) The board may adopt rules and regulations necessary 379
to ensure compliance with this subsection. 380
(2) A pharmacy benefit manager may not deny an appeal 381
submitted pursuant to this section based upon an existing 382
contracted rate with the pharmacy. 383
(3) A pharmacy or pharmacist that belongs to a PSAO must be 384
provided a true and correct copy of a contract and contract 385
amendment that the PSAO enters into with a pharmacy benefit 386
manager or third-party payer on the pharmacy's or pharmacist's 387
behalf. 388
( * * *4) * * * A pharmacy benefit manager or PSAO shall not 389
reimburse a pharmacy or pharmacist in the state an amount less 390
than the amount that the pharmacy benefit manager reimburses a 391
pharmacy benefit manager affiliate for providing the * * * drug, 392
and the amount reimbursed may not be less than the amount 393
prescribed pursuant to subsection (1) of Section 73-21-155. 394
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* * * The reimbursement amount for a drug shall be 395
calculated on a per unit basis based on the same brand and generic 396
product identifier or brand and generic code number. 397
(5) The pharmacy benefit manager or PSAO may not require a 398
pharmacy to collect additional monies following a successful 399
below-cost reimbursement appeal from a person or entity other than 400
the pharmacy benefit manager who adjudicated the drug claim, 401
including the patient or plan sponsor. 402
SECTION 5. Section 73-21-157, Mississippi Code of 1972, is 403
amended as follows: 404
73-21-157. (1) Before beginning to do business as a 405
pharmacy benefit manager or PSAO, a pharmacy benefit manager or 406
PSAO shall obtain a license to do business from the board. To 407
obtain a license, the applicant shall submit an application to the 408
board on a form to be prescribed by the board. The license must 409
be renewed annually. 410
(2) When applying for a license or renewal of a license, 411
each pharmacy benefit manager * * * shall file * * * with the 412
board * * *: 413
(a) (i) A copy of a certified audit report, if the 414
pharmacy benefit manager has been audited by a certified public 415
accountant within the last twenty-four (24) months; of 416
(ii) If the pharmacy benefit manager has not been 417
audited in the last twenty-four (24) months, a financial statement 418
of the organization, including its balance sheet and income 419
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statement for the preceding year which is verified by at least two 420
(2) principal officers; and 421
(b) Any other information relating to the operations of 422
the pharmacy benefit manager or PSAO required by the board * * *. 423
( * * *3) (a) Any information required to be submitted to 424
the board pursuant to licensure application that is considered 425
proprietary by a pharmacy benefit manager or PSAO shall be marked 426
as confidential when submitted to the board. All such information 427
shall not be subject to the provisions of the federal Freedom of 428
Information Act or the Mississippi Public Records Act and shall 429
not be released by the board unless subject to an order from a 430
court of competent jurisdiction. The board shall destroy or 431
delete or cause to be destroyed or deleted all such information 432
thirty (30) days after the board determines that the information 433
is no longer necessary or useful. 434
(b) Any person who knowingly releases, causes to be 435
released or assists in the release of any such information shall 436
be subject to a monetary penalty imposed by the board in an amount 437
not exceeding Fifty Thousand Dollars ($50,000.00) per violation. 438
When the board is considering the imposition of any penalty under 439
this paragraph (b), it shall follow the same policies and 440
procedures provided for the imposition of other sanctions in the 441
Pharmacy Practice Act. Any penalty collected under this paragraph 442
(b) shall be deposited into the special fund of the board and used 443
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to support the operations of the board relating to the regulation 444
of pharmacy benefit managers. 445
(c) All employees of the board who have access to the 446
information described in paragraph (a) of this subsection shall be 447
fingerprinted, and the board shall submit a set of fingerprints 448
for each employee to the Department of Public Safety for the 449
purpose of conducting a criminal history records check. If no 450
disqualifying record is identified at the state level, the 451
Department of Public Safety shall forward the fingerprints to the 452
Federal Bureau of Investigation for a national criminal history 453
records check. 454
( * * *4) * * * The board may waive the requirements for 455
filing financial information for the pharmacy benefit manager if 456
an affiliate of the pharmacy benefit manager is already required 457
to file such information under current law with the Commissioner 458
of Insurance and allow the pharmacy benefit manager to file a copy 459
of documents containing such information with the board in lieu of 460
the statement required by this section. 461
( * * *5) The expense of administering this section shall be 462
assessed annually by the board against all pharmacy benefit 463
managers and PSAOs operating in this state. 464
( * * *6) A pharmacy benefit manager, PSAO or third-party 465
payor * * * shall not require pharmacy accreditation standards 466
or * * * certification requirements inconsistent with, more 467
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stringent than, or in addition to federal and state requirements 468
for licensure as a pharmacy in this state. 469
SECTION 6. The following shall be codified as Section 470
73-21-158, Mississippi Code of 1972: 471
73-21-158. (1) A pharmacy benefit manager is prohibited 472
from engaging in spread pricing. Separately identified 473
administrative fees or costs are exempt from this requirement, if 474
mutually agreed upon in writing by the payor and pharmacy benefit 475
manager. 476
(2) A pharmacy benefit manager or third-party payer may not 477
charge or cause a patient to pay an amount that exceeds the total 478
amount retained by the pharmacy. 479
(3) A pharmacy benefit manager shall pass on to the plan 480
sponsor one hundred percent (100%) of all rebates and other 481
payments that the pharmacy benefit manager received from 482
pharmaceutical manufacturers or rebate aggregators in connection 483
with claims if administered on behalf of the plan sponsor. 484
(4) A pharmacy benefit manager or PSAO may not charge a 485
pharmacist or pharmacy a fee related to the adjudication of a 486
claim, including, without limitation, a fee for: 487
(a) The submission or processing of a claim; 488
(b) The adjudication of a claim; 489
(c) Enrollment or participation in a pharmacy network; 490
or 491
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(d) The development or management of claims processing 492
services or claims payment services related to participation in a 493
pharmacy network. 494
(5) A pharmacy benefit manager or PSAO shall not charge a 495
pharmacist or pharmacy a fee related to participation in a 496
pharmacy network, including, but not limited to, the following: 497
(a) An application fee; 498
(b) An enrollment or participation fee; 499
(c) A credentialing or re-credentialing fee; 500
(d) A change of ownership fee; or 501
(e) A fee for the development or management of claims 502
processing services or claims payment services. 503
SECTION 7. Section 73-21-159, Mississippi Code of 1972, is 504
brought forward as follows: 505
73-21-159. (1) In lieu of or in addition to making its own 506
financial examination of a pharmacy benefit manager, the board may 507
accept the report of a financial examination of other persons 508
responsible for the pharmacy benefit manager under the laws of 509
another state certified by the applicable official of such other 510
state. 511
(2) The board shall coordinate financial examinations of a 512
pharmacy benefit manager that provides pharmacy management benefit 513
plans in this state to ensure an appropriate level of regulatory 514
oversight and to avoid any undue duplication of effort or 515
regulation. The pharmacy benefit manager being examined shall pay 516
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the cost of the examination. The cost of the examination shall be 517
deposited in a special fund that shall provide all expenses for 518
the licensing, supervision and examination of all pharmacy benefit 519
managers subject to regulation under Sections 73-21-71 through 520
73-21-129 and Sections 73-21-151 through 73-21-163. 521
(3) The board may provide a copy of the financial 522
examination to the person or entity who provides or operates the 523
health insurance plan or to a pharmacist or pharmacy. 524
(4) The board is authorized to hire independent financial 525
consultants to conduct financial examinations of a pharmacy 526
benefit manager and to expend funds collected under this section 527
to pay the costs of such examinations. 528
SECTION 8. Section 73-21-161, Mississippi Code of 1972, is 529
amended as follows: 530
73-21-161. (1) As used in this section, the term * * * 531
"steering" means: 532
(a) * * * Directing, ordering or requiring a patient to 533
use a specific affiliate pharmacy or pharmacies for the purpose of 534
filling a prescription or receiving services or other care from a 535
pharmacist; 536
(b) Offering or implementing plan designs that require 537
a patient to utilize an affiliate pharmacy or pharmacies, or that 538
increase costs to a patient, including, but not limited to, 539
requiring a patient to pay the full cost for a prescription drug 540
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when the patient chooses not to use a pharmacy benefit manager 541
affiliate pharmacy; 542
(c) Advertising, marketing or promoting an affiliate 543
pharmacy or pharmacies over another in-network pharmacy, but * * * 544
does not include a pharmacy's inclusion by a pharmacy benefit 545
manager or pharmacy benefit manager affiliate in communications to 546
patients, including patient and prospective patient specific 547
communications, regarding network pharmacies and prices, provided 548
that the pharmacy benefit manager or pharmacy benefit manager 549
affiliate includes information regarding eligible nonaffiliate 550
pharmacies in those communications and the information provided is 551
accurate. 552
(d) Creating a network or engaging in a practice, 553
including accreditation or credentialing standards, day supply 554
requirements or delivery methods requirements, which excludes an 555
in-network pharmacy or restricts an in-network pharmacy from 556
filling a prescription for a prescription drug; or 557
(e) Directly or indirectly engaging in a practice that 558
attempts to influence or induce a pharmaceutical manufacturer to 559
limit the distribution of a prescription drug to a small number of 560
pharmacies or certain types of pharmacies, or to restrict 561
distribution of that drug to nonaffiliate pharmacies. 562
(2) A pharmacy, pharmacy benefit manager, or pharmacy 563
benefit manager affiliate licensed or operating in Mississippi 564
shall be prohibited from: 565
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(a) * * * Steering; 566
(b) Transferring or sharing records relative to 567
prescription information containing patient identifiable and 568
prescriber identifiable data to or from a pharmacy benefit manager 569
affiliate for any commercial purpose; however, nothing in this 570
section shall be construed to prohibit the exchange of 571
prescription information between a pharmacy and its affiliate for 572
the limited purposes of: pharmacy reimbursement; formulary 573
compliance; pharmacy care; public health activities otherwise 574
authorized by law; or utilization review by a health care 575
provider; * * * 576
(c) Presenting a claim for payment to any individual, 577
third-party payor, affiliate, or other entity for a prescription 578
drug or service furnished * * * by steering from * * * a pharmacy 579
benefit manager or pharmacy benefit manager affiliate * * *; or 580
(d) Interfering with the patient's right to choose the 581
patient's pharmacy or provider of choice, including inducement, 582
required referrals or offering financial or other incentives or 583
measures that would constitute a violation of Section 83-9-6. 584
(3) This section shall not be construed to prohibit a 585
pharmacy from entering into an agreement with a pharmacy benefit 586
manager or pharmacy benefit manager affiliate to provide pharmacy 587
care to patients, provided that neither the pharmacy * * * nor the 588
pharmacy benefit manager affiliate violates subsection (2) of this 589
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section and the pharmacy provides the disclosures required in 590
subsection (1) of this section. 591
* * * 592
( * * *4) In addition to any other remedy provided by law, a 593
violation of this section by a pharmacy, pharmacy benefit manager 594
or pharmacy benefit manager affiliate shall be grounds for 595
disciplinary action by the board under its authority granted in 596
this chapter. 597
( * * *5) A pharmacist who fills a prescription that 598
violates subsection (2) of this section shall not be liable under 599
this section. 600
(6) This section does not apply to facilities licensed to 601
fill prescriptions solely for employees of a plan sponsor or 602
employer. 603
SECTION 9. The following shall be codified as Section 604
73-21-162, Mississippi Code of 1972: 605
73-21-162. (1) (a) Retaliation is prohibited. 606
(b) A pharmacy benefit manager, pharmacy benefit 607
manager affiliate or PSAO may not retaliate against a pharmacist 608
or pharmacy based on the pharmacist's or pharmacy's exercise of a 609
right or remedy under this chapter. Retaliation prohibited by 610
this section includes, but is not limited to: 611
(i) Terminating or refusing to renew a contract 612
with the pharmacist or pharmacy; 613
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(ii) Subjecting the pharmacist or pharmacy to an 614
increased frequency of audits, number of claims audited, or amount 615
of monies for claims audited; or 616
(iii) Failing to promptly pay the pharmacist or 617
pharmacy money owed by the pharmacy benefit manager to the 618
pharmacist or pharmacy. 619
(c) For the purposes of this section, a pharmacy 620
benefit manager, pharmacy benefit manager affiliate or PSAO is not 621
considered to have retaliated against a pharmacy if the pharmacy 622
benefit manager: 623
(i) Takes an action in response to a credible 624
allegation of fraud against the pharmacist or pharmacy; and 625
(ii) Provides reasonable notice and a reasonable 626
opportunity to respond to the pharmacist or pharmacy of the 627
allegation of fraud and the basis of the allegation before 628
initiating an action. 629
(2) A pharmacy benefit manager, pharmacy benefit manager 630
affiliate or PSAO may not penalize or retaliate against a 631
pharmacist, pharmacy or pharmacy employee for exercising rights 632
under this chapter, initiating a judicial or regulatory action or 633
discussing or disclosing information pertaining to an agreement 634
with a pharmacy benefit manager or a pharmacy benefit manager 635
affiliate when testifying or otherwise appearing before a 636
governmental agency, legislative member or body, or a judicial 637
authority. 638
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SECTION 10. Section 73-21-163, Mississippi Code of 1972, is 639
amended as follows: 640
73-21-163. (1) Whenever the board has reason to believe 641
that a pharmacy benefit manager * * *, pharmacy benefit manager 642
affiliate or PSAO is using, has used, or is about to use any 643
method, act or practice prohibited in * * * this act and that 644
proceedings would be in the public interest, it may bring an 645
action in the name of the board against the pharmacy benefit 646
manager * * *, pharmacy benefit manager affiliate or PSAO to 647
restrain by temporary or permanent injunction the use of such 648
method, act or practice. The action shall be brought in the 649
Chancery Court of the First Judicial District of Hinds County, 650
Mississippi. The court is authorized to issue temporary or 651
permanent injunctions to restrain and prevent violations of * * * 652
this act, and such injunctions shall be issued without bond. 653
(2) The board may impose a monetary penalty on a pharmacy 654
benefit manager * * *, pharmacy benefit manager affiliate or PSAO 655
for noncompliance with the provisions of * * * this act, in 656
amounts of not less than One Thousand Dollars ($1,000.00) per 657
violation and not more than Twenty-five Thousand Dollars 658
($25,000.00) per violation. Each day a violation continues for 659
the same brand or generic product identifier or brand or generic 660
code number is a separate violation. Each day that a pharmacy 661
benefit manager or PSAO does business in this state without a 662
license is deemed a separate violation. The board shall prepare a 663
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record entered upon its minutes that states the basic facts upon 664
which the monetary penalty was imposed and reduce its decision to 665
writing. Each instance that a pharmacy benefit manager or PSAO 666
fails to comply with the written order of the board is a separate 667
violation of this act. Any penalty collected under this 668
subsection (2) shall be deposited into the special fund of the 669
board. 670
(3) For the purposes of conducting investigations, the 671
board, through its executive director, may conduct audits and 672
examinations of a pharmacy benefit manager or PSAO and also may 673
issue subpoenas to any individual, pharmacy, pharmacy benefit 674
manager, PSAO or other entity having documents or records that it 675
deems relevant to the investigation. 676
(4) The board may assess a monetary penalty for those 677
reasonable costs that are expended by the board in the 678
investigation and conduct of a proceeding, including cost of 679
process service, court reports, expert witnesses and 680
investigators, if the board imposes a monetary penalty under 681
subsection (2) of this section. 682
(5) * * * Monetary * * * penalties and costs assessed and 683
levied under this section shall be paid to the board by the 684
licensee, registrant or permit holder upon the expiration of the 685
period allowed for appeal of those penalties under Section 686
73-21-101, or may be paid sooner if the licensee, registrant or 687
permit holder elects. Any penalty collected by the board under 688
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this subsection ( * * *5) shall be deposited into the special fund 689
of the board. 690
( * * *6) When payment of a monetary penalty assessed and 691
levied by the board against a licensee, registrant or permit 692
holder in accordance with this section is not paid by the 693
licensee, registrant or permit holder when due under this section, 694
the board shall have the power to institute and maintain 695
proceedings in its name for enforcement of payment in the chancery 696
court of the county and judicial district of residence of the 697
licensee, registrant or permit holder, or if the licensee, 698
registrant or permit holder is a nonresident of the State of 699
Mississippi, in the Chancery Court of the First Judicial District 700
of Hinds County, Mississippi. When those proceedings are 701
instituted, the board shall certify the record of its proceedings, 702
together with all documents and evidence, to the chancery court, 703
and the matter shall be heard in due course by the court, which 704
shall review the record and make its determination thereon in 705
accordance with the provisions of Section 73-21-101. The hearing 706
on the matter may, in the discretion of the chancellor, be tried 707
in vacation. 708
(7) (a) The board may conduct audits to ensure compliance 709
with the provisions of this act. In conducting audits, the board 710
may request production of documents pertaining to compliance with 711
the provisions of this act, and documents so requested must be 712
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produced within seven (7) days of the request unless extended by 713
the board or its duly authorized staff. 714
(b) If, after the conclusion of the audit, the pharmacy 715
benefit manager or PSAO is found to be in compliance with all of 716
the requirements of this act, then the board must pay the costs of 717
the audit. However, the pharmacy benefit manager or PSAO being 718
audited shall pay all costs of the audit if the audit reveals 719
noncompliance with this act. The cost of the audit examination 720
must be deposited into the special fund and used by the board, 721
upon appropriation by the Legislature, to support the operations 722
of the board relating to the regulation of pharmacy benefit 723
managers. 724
(c) The board may hire independent consultants to 725
conduct audits of a pharmacy benefit manager or PSAO and expend 726
funds collected under this section to pay the cost of performing 727
audit services. 728
( * * *8) The board shall develop and implement a uniform 729
penalty policy that sets the minimum and maximum penalty for any 730
given violation of * * * this act. The board shall adhere to its 731
uniform penalty policy except in those cases where the board 732
specifically finds, by majority vote, that a penalty in excess of, 733
or less than, the uniform penalty is appropriate. That vote shall 734
be reflected in the minutes of the board and shall not be imposed 735
unless it appears as having been adopted by the board. 736
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SECTION 11. The following shall be codified as Section 737
73-21-165, Mississippi Code of 1972: 738
73-21-165. (1) A pharmacy benefit manager shall report to 739
the board annually, or more often as the board deems necessary, 740
for each plan sponsor the following information: 741
(a) The aggregate amount of rebates and other payments 742
that the pharmacy benefit manager received from pharmaceutical 743
manufacturers or rebate aggregators in connection with claims if 744
administered on behalf of the plan sponsor; 745
(b) The aggregate amount of rebates distributed to each 746
plan sponsor contracted with the pharmacy benefit manager; 747
(c) The aggregate amount of rebates passed on to the 748
enrollees of each plan sponsor at the point of sale that reduced 749
the enrollees' applicable deductible, copayment, coinsurance or 750
other cost-sharing amount; 751
(d) The individual and aggregate amount paid by the 752
plan sponsor to the pharmacy benefit manager for pharmacist 753
services itemized by pharmacy, by product, and by good and 754
services; 755
(e) The individual and aggregate amount a pharmacy 756
benefit manager paid for pharmacist services itemized by pharmacy, 757
product, and by goods and services; and 758
(f) If at any time during the reporting period the 759
pharmacy benefit manager moved or reassigned a prescription drug 760
to a formulary tier that has a higher cost, higher copayment, 761
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higher coinsurance, higher deductible to a consumer, or lower 762
reimbursement to a pharmacy, an explanation of the reason why the 763
drug was moved or reassigned, including whether the move or 764
reassignment was determined or requested by a pharmaceutical 765
manufacturer or other entity. 766
(2) (a) A pharmacy benefit manager shall report annually, in 767
the aggregate, to the board and to a plan sponsor the difference 768
between the amount the pharmacy benefit manager reimbursed a 769
pharmacy and the amount the pharmacy benefit manager charged a 770
plan sponsor. 771
(b) A pharmacy benefit manager shall report to each 772
plan sponsor the aggregate amount of all rebates and other 773
payments that the pharmacy benefit manager received from 774
pharmaceutical manufacturers or rebate aggregators in connection 775
with claims if administered on behalf of the plan sponsor. 776
(3) A pharmacy benefit manager that owns, controls or is 777
affiliated with a pharmacy also shall report annually to the board 778
any difference in reimbursement rates or practices, direct and 779
indirect renumeration fees or other price concessions, and any 780
reduction in reimbursements between a pharmacy that is owned, 781
controlled or affiliated with the pharmacy benefit manager and 782
another pharmacy. 783
SECTION 12. The following shall be codified as Section 784
73-21-167, Mississippi Code of 1972: 785
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73-21-167. (1) There is created the Mississippi Specialty 786
Drug Committee that shall develop a list of prescription drugs 787
that meet the criteria for specialty drug designation to assist 788
with patient access, transparency and responsible cost management. 789
The committee shall meet to review and update the list based on 790
market trends, clinical data and stakeholder input. 791
(2) The committee shall be composed of the following 792
members: 793
(a) A licensed pharmacist from each of the following 794
organizations: the Mississippi Independent Pharmacies 795
Association; the Mississippi Pharmacy Association; the Mississippi 796
Society of Health-System Pharmacists; and the Magnolia State 797
Pharmaceutical Society; 798
(b) Two (2) licensed physicians appointed by the 799
Mississippi State Medical Association; 800
(c) A representative from the Mississippi Association 801
of Health Plans; 802
(d) A representative from Pharmaceutical Care 803
Management Association; 804
(e) A representative from Mississippi Business 805
Alliance; 806
(f) The Executive Director of the State Board of 807
Pharmacy, or his or her designee, to serve as nonvoting temporary 808
chair for the initial organizational meeting of the committee; 809
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(g) A representative from the Office of Insurance of 810
the Department of Finance and Administration; 811
(h) The chair or his or her designee of the Senate Drug 812
Policy Committee, to serve as a nonvoting member; and 813
(i) The chair or his or her designee of the House Drug 814
Policy Committee, to serve as a nonvoting member. 815
(3) (a) Appointments to the committee must be made and 816
provided to the Executive Director of the State Board of Pharmacy 817
before August 1, 2026. Within fifteen (15) days thereafter, on a 818
day to be designated by the executive director of the board, the 819
committee shall meet and organize by selecting from its membership 820
a chair and a vice chair. The vice chair shall serve as secretary 821
and be responsible for keeping all records of the committee. A 822
majority of the members of the committee constitutes a quorum. In 823
the selection of its officers and the adoption of the specialty 824
drug list, rules, resolutions and reports, an affirmative vote of 825
the majority of the voting committee members present is required. 826
All members must be notified in writing of all meetings, and those 827
notices must be mailed at least fifteen (15) days before the date 828
on which a meeting is to be held. 829
(b) The committee shall meet at least once quarterly 830
and shall create the initial list of specialty drugs no later than 831
December 1, 2026. The initial and updated lists of specialty 832
drugs must be posted on the official website of the state agencies 833
and boards serving on the committee. 834
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(4) The State Board of Pharmacy shall provide the office 835
space, staff and other support necessary for the committee to 836
perform its duties. 837
(5) Pharmacy benefit managers licensed with the board shall 838
adhere to the established list of specialty drugs when contracting 839
with a pharmacy and establishing payment levels and adjudicating 840
drug claims or any portion of the transaction. Noncompliance with 841
this subsection shall be deemed a violation of this act. 842
SECTION 13. The following shall be codified as Section 843
73-21-211, Mississippi Code of 1972: 844
73-21-211. Sections 73-21-211 through 73-21-217 shall be 845
known as the "Pharmacy Fair Competition Act." 846
SECTION 14. The following shall be codified as Section 847
73-21-213, Mississippi Code of 1972: 848
73-21-213. The Legislature finds and declares that the 849
distribution and retail sales of pharmaceutical drugs in the State 850
of Mississippi vitally affects the general economy of the state 851
and the public interest and the public welfare. The Legislature 852
further finds and declares that it is necessary, in the exercise 853
of its police power, to regulate, register and/or license drug 854
manufacturers, wholesale distributors, pharmacy service 855
administration organizations and retail pharmacies doing business 856
in the State of Mississippi in order to: 857
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(a) Prevent frauds, unfair practices, discrimination, 858
impositions and other abuses upon the citizens of the State of 859
Mississippi; 860
(b) Avoid undue control of the retail pharmacy by drug 861
manufacturing and distributing organizations, pharmacy service 862
administration organizations or pharmacy benefit managers; 863
(c) Foster and keep alive vigorous and healthy 864
competition; 865
(d) Prevent the creation or perpetuation of monopolies; 866
(e) Prevent the practice of requiring unnecessary 867
requirements on retail pharmacies that add to the costs and timely 868
administration of healthcare to Mississippi citizens; 869
(f) Prevent false and misleading advertising; and 870
(g) Promote the public safety and welfare. 871
SECTION 15. The following shall be codified as Section 872
73-15-215, Mississippi Code of 1972: 873
73-21-215. (1) As used in Sections 73-15-211 through 874
73-15-217, the following words and phrases have the meanings 875
provided in this subsection unless the context clearly requires 876
otherwise: 877
(a) "Board" means the State Board of Pharmacy. 878
(b) "Permit" means a permit issued under Section 879
73-21-105 or Section 73-21-106. 880
(c) "Pharmacy benefit manager" has the same definition 881
as provided in Section 73-21-153. 882
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(d) "Plan sponsor" has the same definition as provided 883
in Section 73-21-153. 884
(2) (a) A pharmacy benefit manager may not acquire direct 885
or indirect interest in, or otherwise hold, directly or 886
indirectly, a pharmacy permit for the retail sale of drugs or 887
medicines in this state. 888
(b) On and after July 1, 2026, the State Board of 889
Pharmacy shall either revoke or not renew a pharmacy permit of an 890
entity that violates this section. 891
(3) (a) The board may issue a limited use permit upon a 892
determination that certain rare, orphan or limited distribution 893
drugs are otherwise unavailable in the market to a patient or a 894
pharmacy which would otherwise be prohibited under this section. 895
(b) The board may assess the need for rare, orphan or 896
limited distribution drugs for a limited use permit for certain 897
rare, orphan or limited distribution drugs under paragraph (a) of 898
this subsection before revocation or renewal of an existing retail 899
permit for a pharmacy. If the assessment made by the board under 900
this paragraph determines that a rare, orphan or limited 901
distribution drug is otherwise unavailable in the market to a 902
patient or pharmacy which would otherwise be prohibited in this 903
section, the board shall convert the retail permit for the 904
prohibited pharmacy to a limited use permit for that pharmacy for 905
a period of no less than ninety (90) days. 906
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(c) A limited use permit may not be issued by the board 907
if a determination is made that the unavailability of the rare, 908
orphan or limited distribution drug has been created by the 909
pharmacy benefit manager or plan sponsor. 910
(4) The process for requesting a limited use permit is as 911
follows: 912
(a) A request by a permitted pharmacy for a limited use 913
permit for a rare, orphan or limited distribution drug unavailable 914
in the market must be made in writing to the board. 915
(b) The written request must provide the name and 916
description of the drug, a detailed description of the patient 917
need for the drug, and an explanation as to why the rare, orphan 918
or limited distribution drug is unavailable in the market. 919
(c) The executive director for the board shall review 920
the written request and make a determination on whether to issue 921
the limited use permit within twenty (20) days from the date of 922
the written request. 923
(d) If the requestor is aggrieved by the decision of 924
the executive director, a petition may be made to the board, in 925
writing, and an administrative hearing on the matter must be held 926
before the board within twenty (20) days of receipt of the 927
petition. 928
(e) Within thirty (30) days after conclusion of the 929
hearing, the board shall reduce its decision to writing and 930
forward an attested true copy thereof to the last-known business 931
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address of the pharmacy permit via United States first-class, 932
certified mail, postage prepaid, and by email to the address 933
provided to the board in its licensing system. 934
(f) If the requestor asserts in the written request 935
that there is a need for an emergency determination due to patient 936
need, a permitted pharmacy may dispense a one-time emergency 937
dispensing of the rare, orphan or limited distribution drug for up 938
to twenty (20) days from the date of the written request pending a 939
decision by the executive director of the board. The written 940
request must include information describing that there is need for 941
an emergency determination due to patient need and provide a 942
detailed reason for the emergency. 943
(5) The board may extend the use of a retail permit or issue 944
a renewal of a retail permit for a pharmacy that offers same-day 945
patient access for pharmacist services, a prescription for a 946
controlled substance, mental health services, or other critical 947
patient healthcare services for a period of time as determined by 948
order of the board if there is a pending sale of the pharmacy to 949
an eligible buyer. 950
(6) This section does not apply to a pharmacy employer or a 951
pharmacy that exclusively services the employees and dependents of 952
the pharmacy employer while utilizing the affiliated pharmacy 953
benefit manager in this state. 954
SECTION 16. The following shall be codified as Section 955
73-21-217, Mississippi Code of 1972: 956
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73-21-217. (1) The board shall conduct an initial 957
assessment of each active retail pharmacy permit issued as of July 958
1, 2026, and shall send written notice at least ninety (90) days 959
before January 1, 2027, to each pharmacy permit holder that the 960
board reasonably believes will be found to be in violation of this 961
act. As used in this subsection, "written notice" means actual 962
notice to the pharmacy permit holder via mail or email, including 963
an email through its licensing system. 964
(2) The written notice required under subsection (1) of this 965
section must include a list of each pharmacy benefit manager that 966
holds a direct or indirect interest in, or otherwise holds, 967
directly or indirectly, a permit under Section 73-21-105 or 968
Section 73-21-106 for the retail sale of drugs or medicines in 969
this state held by the pharmacy permit holder. 970
(3) (a) A pharmacy permit holder with written notice from 971
the board under subsection (1) of this section must provide 972
written notice at least sixty (60) days before January 1, 2027, to 973
each patient and each patient's prescribing healthcare provider 974
that has used the pharmacy within the previous twelve (12) months 975
that the pharmacy can no longer dispense retail drugs to the 976
patient on or after January 1, 2027. As used in this subsection, 977
"written notice" means actual notice to the patient via mail, 978
email, or through the pharmacy's patient portal. 979
(b) A pharmacy that is determined by the board to be in 980
violation of this section after the date set forth in subsection 981
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(1) is not exempt from this act. Within sixty (60) days of a 982
written notice from the board, those pharmacies must provide 983
written notice to each patient and each patient's prescribing 984
healthcare provider that has used the pharmacy within the previous 985
twelve (12) months that the pharmacy can no longer dispense retail 986
drugs to the patient after thirty (30) days from the date of the 987
pharmacy's notice. 988
(4) Each licensed pharmacy benefit manager licensed as of 989
July 1, 2026, shall send a written list to the board, no later 990
than September 1, 2026, of any retail pharmacy that the pharmacy 991
benefit manager holds a direct or indirect interest in, or 992
otherwise holds, directly or indirectly, and is permitted by the 993
board. 994
(5) Each permitted retail pharmacy permitted as of July 1, 995
2026, shall send a written list to the board, no later than 996
September 1, 2026, of any pharmacy benefit manager that holds a 997
direct or indirect interest in, or otherwise holds, directly or 998
indirectly, the permitted retail pharmacy. 999
SECTION 17. Section 25-15-301, Mississippi Code of 1972, is 1000
amended as follows: 1001
25-15-301. (1) The board may contract the administration 1002
and service of the self-insured program to a third party. 1003
Whenever the board chooses to contract with an administrator for 1004
the insurance plan established by Section 25-15-3 et seq. or 1005
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components thereof, it shall comply with the procedures set forth 1006
in this section: 1007
(a) If the board determines that it should contract out 1008
the administration of the plan to an administrator, it shall cause 1009
to be prepared a request for proposals. This request for 1010
proposals shall be prepared for distribution to any interested 1011
party. Notice of the board's intention to seek proposals shall be 1012
published in a newspaper of general circulation at least one (1) 1013
time per week for three (3) weeks before closing the period for 1014
interested parties to respond. Additional forms of notice may 1015
also be used. The newspaper notice shall inform the interested 1016
parties of the service to be contracted, existence of a request 1017
for proposals, how it can be obtained, when a proposal must be 1018
submitted, and to whom the proposal must be submitted. All 1019
requests for proposals shall describe clearly what service is to 1020
be contracted, and shall fully explain the criteria upon which an 1021
evaluation of proposals shall be based. The criteria to be used 1022
for evaluations shall, at minimum, include: 1023
(i) The administrator's proven ability to 1024
handle * * * group accident and health insurance plans comparable 1025
to the plan; 1026
(ii) The efficiency of the claims-paying 1027
procedures; 1028
(iii) * * * The total charges for administering 1029
the plan. 1030
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(b) All proposals submitted by interested parties shall 1031
be evaluated by an internal review committee which shall apply the 1032
same criteria to all proposals when conducting an evaluation. The 1033
committee shall consist of at least three (3) members of the 1034
board. When the proposal under evaluation is for pharmacy 1035
benefits or the management thereof, the Executive Director of the 1036
State Board of Pharmacy, or his or her designee, shall be one (1) 1037
of the members of the evaluation committee. The results and 1038
recommendations of the evaluation shall be presented to the board 1039
for review. All evaluations presented to the board shall be 1040
retained by the board for at least three (3) years. The board may 1041
accept or reject any recommendation of the review committee, or it 1042
may conduct further inquiry into the proposals. Any further 1043
inquiry shall be clearly documented and all methods and 1044
recommendations shall be retained by the board and shall spread 1045
upon its minutes its choice of administrator and its reasons for 1046
making the choice. 1047
(c) (i) The board shall be responsible for preparing a 1048
contract that shall be in accordance with all provisions of this 1049
section and all other provisions of law. The contract shall also 1050
include a requirement that the contractor shall consent to an 1051
evaluation of his performance. Such evaluation shall occur after 1052
the first six (6) months of the contract, and the contractor's 1053
performance shall be reviewed at times the board determines to be 1054
necessary. The contract shall clearly describe the standards upon 1055
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which the contractor shall be evaluated. Evaluations shall 1056
include, but not be limited to, efficiency in claims processing, 1057
including the processing pending claims. 1058
(ii) The PEER Committee, at the request of the 1059
House or Senate Appropriations Committee or the House or Senate 1060
Insurance Committee and with funds specifically appropriated by 1061
the Legislature for such purpose, shall contract with an 1062
accounting firm or with other professionals to conduct a 1063
compliance audit of any administrator responsible for 1064
administering the insurance plan established by Section 25-15-3 et 1065
seq. or components thereof. Such audit shall review the 1066
administrator's compliance with the performance standards required 1067
for inclusion in the administrator's contract. Such audit shall 1068
be delivered to the Legislature no later than January 1. 1069
(iii) An audit for pharmacy benefits or the 1070
management thereof also may be conducted by the State Board of 1071
Pharmacy under the provisions of Chapter 21, Title 73, Mississippi 1072
Code 1972. Any audit conducted by the State Board of Pharmacy 1073
must be provided to the board and the PEER Committee within 1074
fifteen (15) days of final adoption of the results by the State 1075
Board of Pharmacy. 1076
(2) Contracts for the administration of the insurance plan 1077
established in Section 25-15-3 et seq. or components thereof shall 1078
commence at the beginning of the calendar year and shall end on 1079
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the last day of a calendar year. This shall not apply to 1080
contracts provided for in subsection (3) of this section. 1081
(3) If the board determines that it is necessary to not 1082
renew the contract of an administrator, or finds it necessary to 1083
terminate a contract with or without cause as provided for in the 1084
contract of the administrator, the board is authorized to select 1085
an administrator without complying with the bid requirements in 1086
subsections (1) and (2) of this section. Such contracts shall be 1087
for the balance of the calendar year in which the nonrenewal or 1088
termination occurred, and may be for an additional calendar year 1089
if the board determines that the best interests of the plan 1090
members are served by such. Any contract negotiated on an interim 1091
basis shall include a detailed transition plan which shall ensure 1092
the orderly transfer of responsibilities between administrators 1093
and shall include, but not be limited to, provisions regarding the 1094
transfer of records, files and tapes. 1095
(4) Except for contracts executed under the authority of 1096
subsection (3) of this section, the board shall select 1097
administrators at least six (6) months before the expiration of 1098
the current administrator's contract. The period between the 1099
selection of the new administrator and the effective date of the 1100
new contract shall be known as the transition period. Whenever 1101
the newly selected administrator is an entity different from the 1102
entity performing the administrator's function, it shall be the 1103
duty of the board to prepare a detailed transition plan which 1104
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shall insure the orderly transfer of responsibilities between 1105
administrators. This plan shall be effective during the 1106
transition period, and shall include, but not be limited to, 1107
provisions regarding the transfer of records, files and tapes. 1108
Further, the plan shall detail the steps necessary to transfer 1109
records and responsibilities and set deadlines for when such steps 1110
should be completed. The board shall include in all requests for 1111
proposals, contracts with administrators, and all other contracts, 1112
provisions requiring the cooperation of administrators and 1113
contractors in any future transition of responsibilities, and 1114
their cooperation with the board and other contractors with 1115
respect to ongoing coordination and delivery of health plan 1116
services. The board shall furnish the Legislature, Governor and 1117
advisory council with copies of all transition plans and keep them 1118
informed of progress on such plans. 1119
(5) No brokerage fees shall be paid for the securing or 1120
executing of any contracts pertaining to the insurance plan 1121
established by Section 25-15-3 et seq. or components thereof, 1122
whether fully insured or self-insured. 1123
(6) (a) Any corporation, association, company, entity or 1124
individual that contracts with the board for the administration or 1125
service of the self-insured plan shall remit one hundred percent 1126
(100%) of all savings or discounts resulting from any contract to 1127
the board or participant, or both. Any corporation, association, 1128
company, entity or individual that contracts with the board for 1129
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the administration or service of the self-insured plan shall 1130
allow, upon notice by the board, the board or its designee to 1131
audit records of the corporation, association, company, entity or 1132
individual relative to the corporation, association, company, 1133
entity or individual's performance under any contract with the 1134
board. The information maintained by any corporation, 1135
association, company, entity or individual, relating to such 1136
contracts, shall be available for inspection upon request by the 1137
board and such information shall be compiled in a manner that will 1138
provide a clear audit trail. 1139
(b) A corporation, association, company, entity or 1140
individual that contracts with the board for the administration or 1141
service of the pharmacy benefits or management thereof of the 1142
self-insured plan shall comply with the provisions of Chapter 21, 1143
Title 73, Mississippi Code 1972. If there is a conflict in the 1144
application or interpretation of these provisions, then the 1145
provision of those statutes will prevail. 1146
SECTION 18. Section 25-15-303, Mississippi Code of 1972, is 1147
amended as follows: 1148
25-15-303. (1) There is created the State and School 1149
Employees Health Insurance Management Board, which shall 1150
administer the State and School Employees Life and Health 1151
Insurance Plan provided for under Section 25-15-3 et seq. The 1152
State and School Employees Health Insurance Management Board, 1153
hereafter referred to as the "board," shall also be responsible 1154
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for administering all procedures for selecting third-party 1155
administrators provided for in Section 25-15-301. 1156
(2) The board shall consist of the following: 1157
(a) The Chairman of the Workers' Compensation 1158
Commission or his or her designee; 1159
(b) The State Personnel Director, or his or her 1160
designee; 1161
(c) The Commissioner of Insurance, or his or her 1162
designee; 1163
(d) The Commissioner of Higher Education, or his or her 1164
designee; 1165
(e) The State Superintendent of Public Education, or 1166
his or her designee; 1167
(f) The Executive Director of the Department of Finance 1168
and Administration, or his or her designee; 1169
(g) The Executive Director of the Mississippi Community 1170
College Board, or his or her designee; 1171
(h) The Executive Director of the Public Employees' 1172
Retirement System, or his or her designee; 1173
(i) The Executive Director of the State Board of 1174
Pharmacy, or his or her designee; 1175
( * * *j) Two (2) appointees of the Governor whose 1176
terms shall be concurrent with that of the Governor, one (1) of 1177
whom shall have experience in providing actuarial advice to 1178
companies that provide health insurance to large groups and one 1179
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(1) of whom shall have experience in the day-to-day management and 1180
administration of a large self-funded health insurance group; 1181
( * * *k) The Chairman of the Senate Insurance 1182
Committee, or his or her designee; 1183
( * * *l) The Chairman of the House of Representatives 1184
Insurance Committee, or his or her designee; 1185
( * * *m) The Chairman of the Senate Appropriations 1186
Committee, or his or her designee; and 1187
( * * *n) The Chairman of the House of Representatives 1188
Appropriations Committee, or his or her designee. 1189
The legislators, or their designees, shall serve as ex 1190
officio, nonvoting members of the board. 1191
The Executive Director of the Department of Finance and 1192
Administration shall be the chairman of the board. 1193
(3) The board shall meet at least monthly and maintain 1194
minutes of the meetings. A quorum shall consist of a majority of 1195
the authorized voting membership of the board. The board shall 1196
have the sole authority to promulgate rules and regulations 1197
governing the operations of the insurance plans and shall be 1198
vested with all legal authority necessary and proper to perform 1199
this function including, but not limited to: 1200
(a) Defining the scope and coverages provided by the 1201
insurance plan; 1202
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(b) Seeking proposals for services or insurance through 1203
competitive processes where required by law and selecting service 1204
providers or insurers under procedures provided for by law; and 1205
(c) Developing and adopting strategic plans and budgets 1206
for the insurance plan. 1207
The department shall employ a State Insurance Administrator, 1208
who shall be responsible for the day-to-day management and 1209
administration of the insurance plan. The Department of Finance 1210
and Administration shall provide to the board on a full-time basis 1211
personnel and technical support necessary and sufficient to 1212
effectively and efficiently carry out the requirements of this 1213
section. 1214
(4) Members of the board shall not receive any compensation 1215
or per diem, but may receive travel reimbursement provided for 1216
under Section 25-3-41 except that the legislators shall receive 1217
per diem and expenses, which shall be paid from the contingent 1218
expense funds of their respective houses in the same amounts as 1219
provided for committee meetings when the Legislature is not in 1220
session; however, no per diem and expenses for attending meetings 1221
of the board shall be paid while the Legislature is in session. 1222
SECTION 19. If the application or operation of any section, 1223
subsection, paragraph, sentence, clause, word or provision of this 1224
act shall be enjoined or otherwise made inoperative by a court of 1225
competent jurisdiction on the grounds that state or federal law 1226
invalidates the application or operation thereof, this act shall 1227
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ST: Pharmacy Benefit Prompt Pay Act; revise.
be valid and effective in all other applications and operations, 1228
and no section, subsection, paragraph, sentence, clause, word or 1229
other provision shall on account of any pending litigation be 1230
deemed invalid or ineffective except as to that language which has 1231
been enjoined or otherwise made inoperative, then only until the 1232
injunction is removed. 1233
SECTION 20. This act shall take effect and be in force from 1234
and after July 1, 2026. 1235