Pharmacy benefits management.

WORKING DRAFT
2010
STATE OF
WYOMING
10LSO-0240

SENATE FILE
NO.
SF0067

Pharmacy benefits management.

Sponsored by:
Senator(s) Ross, Burns, Landen and Sessions and Representative(s) Buchanan, Gingery and Millin

A BILL

for

AN ACT relating to
health insurance; providing for the regulation of pharmacy benefit managers as specified; requiring annual registration with the insurance commissioner;
requiring rulemaking as specified; providing for penalties;
providing definitions;
and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.
W.S. 26
‑
3
‑
501 through 26
‑
3
‑
504
are created to read:

ARTICLE 5
PHARMACY BENEFIT MANAGERS

26
‑
3
‑
5
01.

Annual registration
required
; fees; disposition of fees
.

(a)

Any pharmacy benefit manager that does business in this state shall register

annually with the commissioner and pay a
n annual
fee
established by the
commissioner

in accordance with the following:

(i)

Fees shall be established by rule or regulation promulgated in accordance with the Wyoming Administrative Procedure Act;

(ii)

Fees shall be established in an amount to ensure that, to the extent practicable, the total revenue generated from the fees collected approximates, but does not exceed, the direct and indirect costs of administering the regulatory provisions required for pharmacy benefit managers under this article;

(iii)

The commissioner shall maintain records sufficient to support the fees charged.

(b)

Fees collected by the commissioner under this section shall be deposited in the state treasury and credited
as provided in W.S. 26-2-205(c).

26
‑
3
‑
5
0
2
.

Definitions.

(a)

As used in this a
r
t
icle
:

(i)

"Covered entity"
means
a no
n
profit hospital or medical service organization, insurer, health coverage plan or health maintenance organization or an employer,
labor
union or other group of persons organized in the state that provides health coverage to covered individuals who are employed or reside in the state. "Covered entity" does not include a health plan that provides coverage only for accidental injury,
specified
disease, hospital indemnity, medicare supplement, disability income, long-term care or other limited benefit health insurance policies and contracts;

(ii)

"Covered
individual
" means a member, participant, enrollee, contract holder or policy holder or beneficiary of a covered entity who is provided health
care
coverage by the covered entity
and
includes a dependent
or other
individual
provided health care coverage through a policy, contract or plan for a covered
individual
;

(i
ii
)

"Pharmacy benefits management" means the administration of prescription drug benefits provided by a covered entity for the benefit of covered individuals;

(
i
v)

"Pharmacy benefits manager" means a person, business or other entity that performs
pharmacy
benefits management, including a person or entity acting for a pharmacy benefits manager
in a contractual or
employment
relationship in the performance of pharmacy benefits management for a covered entity.

26
‑
3
‑
5
0
3
.

Pharmacy benefits managers; authorized activities
and disclosures
; prohibition
against mandating use of mail order pharmacies
.

(a)

A pharmacy benefits manager shall:

(i)

Perform its duties exercising good faith and fair dealing toward the covered entity;

(ii)

Notify the covered entity of the availability of administrative services

only
contracts
to manage prescriptions;

(iii)

Disclose to the covered entity all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefits manager and any prescription drug manufacturer or labeler, including formulary management and drug substitution programs, educational support, claims processing and pharmacy network fees that are charged from retail pharmacies and data sales fees. A pharmacy benefits manager disclosing information
under
this paragraph may designate that material as confidential. Information designated as confidential by a pharmacy benefits manager
and disclosed to a covered entity under this paragraph may not be disclosed by the covered entity to any person without the consent of the pharmacy benefits manager, except that disclosure under this paragraph may be made under a court order issued in this state;

(iv)

Disclose to the covered entity any agreement to sell prescription drug data, including data concerning the prescribing practices of the health care providers in the state;

(v)

Disclose to the covered entity, if the pharmacy benefits manager makes a substitution for a prescribed drug
as authorized under the Wyoming Generic Drug Substitution Act, W.S. 33
‑
24
‑
146 et seq.
,
the cost of both
the prescribed and the substituted
drugs and any benefit or payment directly or indirectly accruing to the pharmacy benefits manager as a result of the substitution;

(vi)

Notify the covered entity in writing of any activity, policy or practice of the pharmacy benefits manager that directly or indirectly presents any conflict of interest with the duties imposed by this section, including discriminatory pricing procedures that favor the use of mail order pharmacies over retail pharmacies.

(b)

A pharmacy benefits manager shall not require a covered individual to use a mail order pharmacy.

26
‑
3
‑
504.

Penalties for violations.

Any pharmacy benefits manager or covered entity violating the provisions of this article
may
be subject to penalties as provided in W.S. 26
‑
1
‑
107.

Section 2.
This act is effective July 1, 20
10
.

(END)

1
SF0067