Home Table of Contents

§ 449.1. Prescription drug pricing study

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 62 P.S. Poor Persons and Public WelfareEffective: January 25, 2021

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 62 P.S. Poor Persons and Public Welfare (Refs & Annos)
Chapter 1. Human Services Code (Refs & Annos)
Article IV. Public Assistance (Refs & Annos)
(f) Medical Assistance (Refs & Annos)
Effective: January 25, 2021
62 P.S. § 449.1
§ 449.1. Prescription drug pricing study
Currentness
(a) The Legislative Budget and Finance Committee shall conduct a study analyzing prescription drug pricing under the medical assistance managed care program. The committee shall do all of the following as it relates to the medical assistance managed care program only:
(1) Provide an overview of the distribution of and payment for pharmaceuticals in the medical assistance managed care program.
(2) Review the reimbursement practices of pharmacy benefit managers to pharmacies within this Commonwealth.
(3) Review the reimbursement practices of managed care organizations to pharmacy benefit managers.
(4) Investigate and compare the reimbursement rates paid by pharmacy benefit managers to independent pharmacies and to chain pharmacies.
(5) Study the best practices and laws adopted by other states to address concerns with pharmacy reimbursement practices of pharmacy benefit managers.
(b) The Legislative Budget and Finance Committee shall review and utilize data from the most recent twelve-month period.
(c) The department shall provide the following data for the medical assistance managed care program to the Legislative Budget and Finance Committee:
(1) The amount paid to a pharmacy provider per claim, including ingredient cost and the amount of any copayment deducted from the payment.
(2) The transmission fees charged by a pharmacy benefit manager to a pharmacy provider.
(3) The amount charged by the pharmacy benefit manager to the medical assistance managed care organization per claim, including all administrative fees and processing charges associated with the claim.
(4) Rebates paid by the pharmacy benefit manager to the managed care organization.
(5) Any other data the Legislative Budget and Finance Committee deems necessary.
(d) Pharmacy benefit managers and medical assistance managed care organizations shall provide the required data under subsection (c) to the department within forty-five days of the effective date of this section for distribution to the Legislative Budget and Finance Committee. The providing of data by the pharmacy benefit managers and medical assistance managed care organizations to the department or by the department to the Legislative Budget and Finance Committee shall not constitute a waiver of any applicable privilege or claim of confidentiality. All data shall be given confidential treatment, shall not be subject to subpoena by a third-party entity and may not be made public or otherwise shared by the department, the Legislative Budget and Finance Committee or any other person except to the extent allowed under this subsection.
(e) All data provided under subsection (b) for purposes of conducting the study shall be in a form that is de-identified of personal health information.
(f) The Legislative Budget and Finance Committee shall publish only aggregate data in the report. Any information disclosed or produced by a pharmacy benefit manager or a medical assistance managed care organization for the purposes of this study shall be confidential and not be subject to the act of February 14, 2008 (P.L. 6, No. 3),1 known as the “Right-to-Know Law.”
(g) The Legislative Budget and Finance Committee shall submit a report of its findings and recommendations for legislative action to the General Assembly and the department within twelve months of the receipt of the data from the department under subsection (c).
(h) As used in this section, the following words and phrases shall have the meanings given to them in this subsection:
“Adjudicated claim” shall have the same meaning as the term does in section 449.2
“Entity” shall have the same meaning as the term does in section 449.
“Pharmacy benefit management” shall have the same meaning as the term does in section 449.
“Pharmacy benefit manager” shall have the same meaning as the term does in section 449.
“Pharmacy services administration organization” shall have the same meaning as the term does in section 449.

Credits

1967, June 13, P.L. 31, No. 21, art. 4, § 449.1, added 2020, Nov. 25, P.L. 1208, No. 120, § 2, effective in 60 days [Jan. 25, 2021].

Footnotes

1
65 P.S. § 67.101 et seq.
2
62 P.S. § 449.
62 P.S. § 449.1, PA ST 62 P.S. § 449.1
Current through Act 13 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
End of Document