Pharmacy benefit managers-prohibited practices.

2018
STATE OF WYOMING
18LSO-0329
Numbered
1.2

HOUSE BILL

NO.
HB0107

Pharmacy benefit managers-prohibited practices.

Sponsored by:
Representative(s) Kirkbride, Blackburn, Brown, Furphy, Larsen, Sweeney and Zwonitzer and Senator(s) Boner and Pappas

A BILL

for

AN ACT relating to pharmacy benefit managers; prohibiting specified practices by pharmacy benefit managers and insurers; authorizing specified audits; establishing civil liability for specified violations; making conforming amendments; specifying applicability of certain provisions; and providing for an effective date.

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

Section
1
.

W.S.
9
‑
3
‑
219
, 26
‑
34
‑
136,
26
‑
52
‑
105
and 26
‑
52
‑
106 are
created to read:

9
‑
3
‑
219
.

Applicability of specified provisions.

W.S. 26
‑
52
‑
105 applies to a health insurance plan issued under this article.

26
‑
34
‑
136
.

Applicability of specified provisions.

W.S. 26
‑
52
‑
105 applies to group health insurance or a health care plan issued by a health maintenance organization under this chapter.

26
‑
52
‑
105
.

Prohibited practices
; audits
.

(a)

A
pha
rmacy benefit manager
or an insurer shall
not require an

insured person to make a payment at the point of sale
of
a prescription in an amount greater than the lesser of the:

(
i
)

Applicable copayment, coinsurance or
other
cost
‑
sharing requirement

set forth in a private health benefit plan
;

(ii)

Amount the insurer has contracted or otherwise agreed
in advance
to pay or reimburse the pharmacy for the prescription;
or

(iii)

Amount the insured person would pay for the prescription if the person purchased the prescription without
coverage from
a private health benefit plan.

(b)

An insurer, a pharmacy benefit manager and any contract or agreement
made
by an insurer or a pharmacy benefit manager
with a pharmacy
shall not
incentivize a pharmacy not to take the actions specified in paragraph (
i
) of this subsection and shall not
prohibit or penalize
in any manner, including through
increased utilization review,
reduced payments or reimbursements
or other financial disincentives
,

the following actions
by a pharmacy
:

(
i
)

Disclosure
of any data
to an insured person relating to:

(A)

T
he cost of a prescription
;

(B)

A
ny payments or reimbursements made to t
he pharmacy by an insurer or a
pharmacy
benefit manager
relating to a
prescription
.

(ii)

Disclosure of t
he a
vailability of a therapeutic
equivalent or alternative methods of purchasing
a
prescription, including paying a cash price or utilizing a
prescription
discount
or assistance
program
.

(c
)

A pharmacy benefit
manager shall not impose a charge on a pharmacy relating to the:

(
i
)

Receipt or
processing of a claim
for payment or reimbursement
;

(ii)

Development or management of a claim processing network;

(iii)

Participation
of the pharmacy
in a claim processing network.

(d)

A pharmacy benefit manager shall not contract or otherwise agree with an insurer to increase any premium, copayment, coinsurance, deductible or
other cost
‑
sharing requirement
or reduce any benefit based on the requirements of this section.

(e)

The commissioner may
examine
an insurer, pharmacy, pharmacy benefit manager
,
any designee of the pharmacy who holds a contract with a pharmacy benefit manager

or any other related entity to ensu
re compliance with this section,
in
the manner pre
scribed by
W.S. 26
‑
2
‑
116 through 26
‑
2
‑
124.

(f)

This section shall supersede any other provision of law, contract or agreement to the extent necessary to implement this section.

(g)

As used in this section, "pharmacy" shall include a pharmacist.

26
‑
52
‑
106
.

Civil liability for specified violations
;
defenses;
applicability
.

(a
)

A person injured by a violation of
W.S. 26
‑
52
‑
105
may maintain a civil action against the person who committed the violation and recover actua
l and consequential damages,
reasonable
attorney's fees
and court costs
relating to the injury.

(b
)

A defendant of a civil action brought under subsection (a) of this section:

(
i
)

Shall not assert
,
a
s a
partial or complete
defense
,
that the defendant did not have direct
interaction
with
a
plaintiff;

(ii)

May, in order to avoid duplicative liability, assert a
s a
partial or complete defense that
any charge prohibited by W.S. 26
‑
52
‑
105 was passed along
by a person who paid the charge
to another person in the chain of commerce.

(c)

Except as otherwise provided by the Wyoming Governmental Claims Act, W.S. 1
‑
39
‑
101

through 1
‑
39
‑
120, this section shall not apply to an action or inaction of an employee or officer of a governmental entity, as defined in W.S. 1
‑
39
‑
103(a)(
i
).

Section 2
.

W.S.
26
‑
2
‑
117(a
)(intro),
26
‑
2
‑
122(a) and
26
‑
52
‑
102(a)
(ii),
(vi) and
by creating
new paragraph
s
(viii)
and (ix)
are
amended to read:

26
‑
2
‑
117
.

Examination of other than insurers.

(a)

For the purpose of ascertaining compliance with law, or relationships and transactions between any person and any insurer or proposed insurer, the commissioner, as often as he deems advisable, may examine the accounts, records, documents and transactions pertaining to or affecting
any requirement of W.S. 26
‑
52
‑
105 or the

insurance affairs or

proposed insurance affairs of any person:

26
‑
2
‑
122
.

Examinations; expense.

(a)

The reasonable and proper expense of examination of an insurer or of any person referred to in W.S. 26
‑
2
‑
117(a)(ii) or (iv)
or any person examined pursuant to W.S. 26
‑
52
‑
105(e)

shall be borne by the person examined, unless the expense has been otherwise provided for by the insurer having paid the assessment established by W.S. 26
‑
2
‑
204. The expense shall include the reasonable and proper expenses of the commissioner and his examiners, and a reasonable per diem as to such examiners, as necessarily incurred in the examination.

26
‑
52
‑
102
.

Definitions.

(a)

As used in this article:

(ii)

"Insurer" means the entity defined in W.S. 26
‑
1
‑
102(a)(xvi) and who provides health insurance coverage in this state
and includes a health maintenance organization, the
state
employees' and officials' health group insurance plan and any
provider of a
plan made available under W.S. 9
‑
3
‑
201
;

(vi)

"Pharmacy" means an entity through which pharmacists or other persons practice pharmacy as specified in W.S. 33
‑
24
‑
124
and includes any designee of the pharmacy who holds a contract with a pharmacy benefit manager
;

(viii)

"Private health benefit plan" means as defined in W.S. 26
‑
1
‑
10
2
(a)(xxxiii), and
includes
a
nonfully
funded multip
le employer welfare arrangement, the
state
employees' and officials' health group insurance plan and any plan ma
de available under W.S. 9
‑
3
‑
201;

(ix)

"Therapeutically equivalent" or "therapeutic equivalent" means as defined in W.S. 33
‑
24
‑
147(a)(v).

Section 3
.

This act is effective
January
1, 201
9
.

(END)

1
HB0107