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21LSO-0440
2021
STATE OF WYOMING
21LSO-0440
Numbered
2.0
SENATE FILE NO. SF0151
Pharmacy freedom of choice.
Sponsored by: Senator(s) Nethercott
A BILL
for
AN ACT relating to insurance; prohibiting insurers and pharmacy benefit managers from imposing limitations on covered persons utilizing pharmacy benefits and options as specified; prohibiting pharmacists and pharmacies from restricting a covered person's ability to use a pharmacy of the person's choosing as specified; imposing limits on the right to participate in pharmacy network contracts as specified; providing definitions; making conforming amendments; specifying applicability; requiring rulemaking; and providing for effective dates.
Be It Enacted by the Legislature of the State of Wyoming:
Section 1
.
W.S. 9
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3
‑
220, 26
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18
‑
401, 26
‑
18
‑
402 and 26
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52
‑
105 are created to read:
9
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3
‑
220.
Applicability of pharmacy choice provisions.
The provisions of W.S. 26
‑
43
‑
301 and 26
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43
‑
302 shall apply to any disability insurance plan, including health insurance plans, issued under this article on or after July 1, 2021.
ARTICLE 4
PHARMACY CHOICE
26
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18
‑
401.
Definitions.
(a)
As used in this article:
(i)
"Covered person" means a person entitled to receive benefits or services under disability insurance as defined by W.S. 26
‑
5
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103(a)(ii), including health insurance, offered or provided by an insurer or a person who receives benefits through a pharmacy benefit manager;
(ii)
"Insurer" means an entity defined in W.S. 26
‑
1
‑
102(a)(xvi) and who offers disability insurance as defined by W.S. 26
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5
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103(a)(ii), including health insurance, in this state. "Insurer" shall include a health maintenance organization, the state employees' and officials' health group insurance plan and any provider of a plan made available under the State Employees and Officials Group Insurance Act;
(iii)
"Pharmacy" means an entity through which pharmacists or other persons practice pharmacy as specified by W.S. 33
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24
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124 and includes a pharmacist and any designee of the pharmacy who holds a contract with a pharmacy benefit manager;
(iv)
"Pharmacy benefit manager" means as defined by W.S. 26
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52
‑
102(a)(vii).
26
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18
‑
402.
Patient choice of pharmacy.
(a)
No insurer that offers or provides prescription drug coverage or that covers pharmacy services and no pharmacy benefit manager shall:
(i)
Limit or restrict a covered person's ability to select a pharmacy if the pharmacy selected by the person is licensed under title 33, chapter 24 of the Wyoming statutes;
(ii)
Impose a copayment, fee or any cost
‑
sharing requirement on a covered person or a pharmacy for the covered person's selection of a pharmacy unless the insurer or pharmacy benefit manager imposes the same copayment, fee or other cost
‑
sharing requirement on all covered persons or pharmacies in Wyoming;
(iii)
Impose any conditions or restrictions on a covered person or pharmacy that limit or restrict a covered person's ability to use a pharmacy of the covered person's choice;
(iv)
After a covered person has chosen a pharmacy, deny the chosen pharmacy the right to participate in any of its pharmacy network contracts in Wyoming or as a contracted provider in Wyoming if the pharmacy is licensed under title 33, chapter 24 of the Wyoming statutes and the pharmacy agrees to:
(A)
Accept the terms and conditions that are offered by the insurer or pharmacy benefit manager that are offered to any other pharmacy in Wyoming and that were accepted by any other pharmacy in Wyoming;
(B)
Provide pharmacy or prescription drug services that satisfy applicable state and federal laws and regulations.
(b)
This section shall not apply to:
(i)
Pharmacy or prescription drug services administered to a person receiving inpatient or emergency medical care in a facility licensed under W.S. 35
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2
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901 through 35
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2
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913 or in a facility operated by the federal
government that would otherwise be required to be licensed under W.S. 35
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2
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901 through 35
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2
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913;
(ii)
A self
‑
funded plan that is exempt from state regulation pursuant to the federal Employee Retirement Income Security Act of 1974;
(iii)
Licensed medical professionals acting within the scope of their license while working in a private clinic that is not licensed under title 35 of the Wyoming statutes;
(iv)
A plan issued for coverage for federal employees.
(c)
The commissioner may examine any insurer, pharmacy, pharmacy benefit manager, any designee of the pharmacy that holds a contract with a pharmacy benefit manager or any other related entity to ensure compliance with this section in the manner prescribed by W.S. 26
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2
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116 through 26
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2
‑
124.
26
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52
‑
105.
Applicability of pharmacy choice provisions.
The provisions of W.S. 26
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43
‑
301 and 26
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43
‑
302 shall apply to pharmacy benefit managers or contracts entered into by pharmacy benefit managers with pharmacies on or after July 1, 2021.
Section 2.
W.S. 9
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3
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203(a)(xvii), 26
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2
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117(a)(intro), 26
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2
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122(a), 26
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34
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102(a)(xxix) and 26
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34
‑
135 by creating a new subsection (e) are amended to read:
9
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3
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203.
Definitions.
(a)
As used in this act:
(xvii)
"This act" means W.S. 9
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3
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202 through
9
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3
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219
9
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3
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220
.
26
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2
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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
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18
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402 or the
insurance affairs or proposed insurance affairs of any person:
26
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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
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2
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117(a)(ii) or (iv)
or of any person examined under W.S. 26
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18
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402(c)
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
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2
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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
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34
‑
102.
Definitions.
(a)
As used in this chapter:
(xxix)
"This act" means W.S. 26
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34
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101 through
26
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34
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134
26
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34
‑
135
.
26
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34
‑
135.
Application of other laws.
(e)
The provisions of W.S. 26
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18
‑
401 and 26
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18
‑
402 shall apply to group health insurance or a health care plan issued by a health maintenance organization licensed under this chapter.
Section 3
.
The provisions of this act shall apply to all health benefit plans, disability insurance and pharmacy benefit contracts entered into, issued, delivered or renewed on or after July 1, 2021.
Section 4.
The insurance commissioner shall promulgate any rules necessary to implement the provisions of this act.
Section 5.
(a) Except as provided in subsection (b) of this section, this act is effective July 1, 2021.
(b) Sections 4 and 5 of this act are
effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.
(END)
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SF0151