Amendment vs bill Amendment Report for House Bill No. 1123 vs Current version

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MISSISSIPPI LEGISLATURE REGULAR SESSION 2025 By:
Senate Amendments to House Bill No.
Representatives White, Owen To:
1123 TO THE CLERK OF THE HOUSE:
State Affairs HOUSE BILL NO.
THIS IS TO INFORM YOU THAT THE SENATE HAS ADOPTED THE AMENDMENTS SET OUT BELOW:
1123 AN ACT TO PROHIBIT SPREAD PRICING;
AMENDMENT NO.
TO REQUIRE EACH DRUG MANUFACTURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES THE CURRENT WHOLESALE ACQUISITION COST;
1 Amend by striking all after the enacting clause and inserting in lieu thereof the following:
TO REQUIRE SUCH ENTITIES TO PROVIDE THE BOARD OF PHARMACY WITH VARIOUS DRUG PRICING INFORMATION WITHIN A CERTAIN TIME;
TO REQUIRE PHARMACY BENEFIT MANAGERS AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS TO FILE A REPORT WITH THE BOARD OF PHARMACY;
TO REQUIRE EACH HEALTH INSURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES CERTAIN DRUG PRESCRIPTION INFORMATION;
TO REQUIRE THE BOARD OF PHARMACY TO DEVELOP A WEBSITE TO PUBLISH INFORMATION RELATED TO THE ACT;
TO PROHIBIT PHARMACY BENEFIT MANAGERS AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS FROM RETALIATING AGAINST PHARMACISTS OR PHARMACIES FOR TAKING CERTAIN ACTIONS;
TO AUTHORIZE THE BOARD OF PHARMACY TO CONDUCT INVESTIGATIONS, ISSUE SUBPOENAS, CONDUCT AUDITS AND IMPOSE A MONETARY PENALTY FOR VIOLATIONS RELATED TO THE ACT;
TO REQUIRE PHARMACY BENEFIT MANAGERS AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS TO IDENTIFY OWNERSHIP AFFILIATION OF ANY KIND TO THE BOARD OF PHARMACY;
TO BRING FORWARD SECTIONS 73-21-155, 73-21-156 AND 73-21-183, MISSISSIPPI CODE OF 1972, FOR THE PURPOSE OF POSSIBLE AMENDMENT;
AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
The following words and phrases shall have the meanings as defined in this section unless the context clearly indicates otherwise:
Section 73-21-151, Mississippi Code of 1972, is amended as follows:
(a) "Board" means the Mississippi Board of Pharmacy.
73-21-151.
H.
Sections 73-21-151 through * * * 73-21-169 shall be known as the "Pharmacy Benefit Prompt Pay Act." SECTION 2.
B.
Section 73-21-153, Mississippi Code of 1972, is amended as follows:
No.
73-21-153.
1123 *HR31/R1411* ~ OFFICIAL ~ G1/2 25/HR31/R1411 PAGE 1 (ENK\JAB) (b) "Pharmacy services administrative organization" (PSAO) means an entity operating within the state that contracts with one or more independent pharmacies to conduct business on their behalf with third-party payers.
For purposes of Sections 73-21-151 through * * * 73-21-169, the following words and phrases shall have the meanings ascribed herein unless the context clearly indicates otherwise:
PSAOs provide administrative services to pharmacies and negotiate and enter into contracts with third-party payers or pharmacy benefit managers on behalf of pharmacies.
(a) "Board" means the * * * Mississippi Board of Pharmacy.
A person or entity is a PSAO for purposes of this act if it performs one or more of the following administrative services on behalf of one or more pharmacies, including, but not limited to:
(b) "Clean claim" means a completed billing instrument, paper or electronic, received by a pharmacy benefit manager from a pharmacist or pharmacies or the insured, which is accepted and payment remittance advice is provided by the pharmacy benefit manager.
(i) Assistance with claims;
A clean claim includes resubmitted claims with previously identified deficiencies corrected.
(ii) Assistance with audits;
PAGE 11123 ( * * *c) "Commissioner" means the Mississippi Commissioner of Insurance.
(iii) Assistance with access to pharmacy networks;
( * * *d) "Day" means a calendar day, unless otherwise defined or limited.
(iv) Assistance with interactions between the pharmacy and pharmacy benefit manager;
( * * *e) "Electronic claim" means the transmission of data for purposes of payment of covered prescription drugs, other products and supplies, and pharmacist services in an electronic data format specified by a pharmacy benefit manager and approved by the department.
(v) Centralized payment;
( * * *f) "Electronic adjudication" means the process of electronically receiving * * * and reviewing an electronic claim and either accepting and providing payment remittance advice for the electronic claim or rejecting * * * the electronic claim.
(vi) Certification in specialized care programs;
( * * *g) "Enrollee" means an individual who has been enrolled in a pharmacy benefit management plan or health insurance plan.
(vii) Compliance support;
( * * *h) "Health insurance plan" means benefits consisting of prescription drugs, other products and supplies, and pharmacist services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as prescription drugs, other products and supplies, and pharmacist services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization agreement, or health maintenance organization contract offered by a health insurance issuer.
(viii) Setting flat fees for generic drugs;
PAGE 21123 (i) "Network pharmacy" means a pharmacy licensed by the board and provides pharmacy services to Mississippi consumers and has a contract with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate.
(ix) Assistance with store layout;
(j) "Payment remittance advice" means the claim detail that the pharmacy receives when successfully processing an electronic or paper claim.
(x) Marketing support;
The claim detail shall contain, but is not limited to:
(xi) Analysis of payment and drug dispensing data;
(i) The amount that the pharmacy benefit manager will reimburse for product ingredient;
or (xii) Provision of resources for retail cash cards.
and (ii) The amount that the pharmacy benefit manager will reimburse for product dispensing fee;
H.
and (iii) The amount that the pharmacy benefit manager dictates the patient must pay.
B.
(k) "Pharmacist * * *" and "pharmacy" or "pharmacies" shall have the same definition as provided in Section 73-21-73.
No.
( * * *l) "Pharmacy benefit manager" * * * means an entity that provides pharmacy benefit management services.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 2(ENK\JAB) (c) "Proprietary information" means information on pricing, costs, revenue, taxes, market share, negotiating strategies, customers and personnel that is held by a pharmacy benefit manager or PSAO and used for its business purposes.
* * * The term "pharmacy benefit manager" shall not include:
(d) "Spread pricing" means any amount charged or claimed by a pharmacy benefit manager or PSAO in excess of the ingredient cost for a dispensed prescription drug plus dispensing fee paid directly or indirectly to any pharmacy, pharmacist, or other provider on behalf of the health benefit plan, less a pharmacy benefit management or PSAO fee.
(i) An insurance company unless the insurance company is providing services as a pharmacy benefit manager * * *, in which case the insurance company shall be subject to Sections 73-21-151 through * * * 73-21-169 only for those pharmacy benefit manager services * * *;
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SECTION 2.
and PAGE 31123 (ii) The Mississippi Division of Medicaid or its contractors when performing pharmacy benefit manager services for the Division of Medicaid.
(1) Except as otherwise provided in subsection (3), no pharmacy benefit manager, PSAO, carrier, or health benefit plan may, either directly or through an intermediary, agent, or affiliate engage in, facilitate, or enter into a contract with another person involving spread pricing in this state.
( * * *m) "Pharmacy benefit manager affiliate" means * * * an entity that directly or indirectly, * * * owns or controls, is owned or controlled by, or is under common ownership or control with a pharmacy benefit manager.
(2) A pharmacy benefit manager or PSAO contract with a carrier or health benefit plan entered into, renewed, or amended on or after the effective date of this act must:
( * * *n) "Pharmacy benefit management plan" * * * means an arrangement for the delivery of pharmacist's services in which a pharmacy benefit manager undertakes to administer the payment or reimbursement of any of the costs of pharmacist's services, drugs or devices.
(a) Specify all forms of revenue, including pharmacy benefit management or PSAO fees, to be paid by the carrier or health benefit plan to the pharmacy benefit manager or PSAO;
* * * (o) "Pharmacy benefit management services" shall include, but is not limited to, the following services, which may be provided either directly or through outsourcing or contracts:
and (b) Acknowledge that spread pricing is not permitted in accordance with this section.
(i) Adjudicate drug claims or any portion of the transaction.
(3) The provisions of this section shall not apply to any self-funded health plans.
(ii) Contract with retail and mail pharmacy networks.
H.
(iii) Establish payment levels for pharmacies.
B.
(iv) Develop formulary or drug list of covered therapies.
No.
(v) Provide benefit design consultation.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 3(ENK\JAB) SECTION 3.
(vi) Manage cost and utilization trends.
(1) Each drug manufacturer shall submit a report to the Mississippi Board of Pharmacy no later than the fifteenth day of January, April, July, and October with the current wholesale acquisition cost information for the prescription drugs sold in or into the state by that drug manufacturer;
(vii) Contract for manufacturer rebates.
provided, however, the first report due under this subsection shall not be due until October 1, 2025.
PAGE 41123 (viii) Provide fee-based clinical services to improve member care;
(2) Not more than thirty (30) days after an increase in wholesale acquisition cost of forty percent (40%) or greater over the preceding five (5) calendar years or ten percent (10%) or greater in the preceding twelve (12) months for a prescription drug with a wholesale acquisition cost of Seventy Dollars ($70.00) or more for a manufacturer-packaged drug container, a drug manufacturer shall submit a report to the board.
and (ix) Third-party administration.
The report must contain the following information:
(p) "Pharmacist services" means products, goods and services, or any combination of products, goods and services, provided as part of the practice of pharmacy.
(a) Name of the drug;
(q) "Pharmacy services administrative organization" or "PSAO" means any entity that contracts with a pharmacy or pharmacist to assist with third-party payor interactions and that may provide a variety of other administrative services, including, but not limited to, contracting with third-party payers or pharmacy benefit managers on behalf of pharmacies and providing pharmacies or pharmacists with credentialing, billing, audit, general business and analytic support.
(b) Whether the drug is a brand name or a generic;
( * * *r) "Plan sponsors" means the employers, insurance companies, unions and health maintenance organizations that contract, either directly or indirectly, with a pharmacy benefit manager for delivery of prescription drugs and/or services.
(c) The effective date of the change in wholesale acquisition cost;
(s) "Proprietary information" means information on pricing, costs, revenue, taxes, market share, negotiating strategies, customers and personnel that is held by a pharmacy benefit manager, drug manufacturer or PSAO and used for its business purposes.
(d) Aggregate, company-level research and development costs for the previous calendar year;
(t) "Rebate" means any and all payments and price concessions that accrue to a pharmacy benefit manager or its plan PAGE 51123 sponsor client, directly or indirectly, including through an affiliate, subsidiary, third party or intermediary, including off-shore group purchasing organizations, from a pharmaceutical manufacturer, its affiliate, subsidiary, third party or intermediary, including, but not limited, to payments, discounts, administration fees, credits, incentives or penalties associated directly or indirectly in any way with claims administered on behalf of a plan sponsor.
(e) Aggregate rebate amounts paid to each pharmacy benefit manager or PSAO for the previous calendar year;
(u) "Spread pricing" means any amount charged or claimed by a pharmacy benefit manager or PSAO in excess of the ingredient cost for a dispensed prescription drug plus dispensing fee paid directly or indirectly to any pharmacy, pharmacist or other provider on behalf of the health benefit plan, less a pharmacy benefit management or PSAO fee.
H.
( * * *v) "Uniform claim form" means a form prescribed by rule by the * * * board;
B.
however, for purposes of Sections 73-21-151 through * * * 73-21-169, the board shall adopt the same definition or rule where the State Department of Insurance has adopted a rule covering the same type of claim.
No.
The board may modify the terminology of the rule and form when necessary to comply with the provisions of Sections 73-21-151 through * * * 73-21-169.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 4(ENK\JAB) (f) The name of each of the drug manufacturer's drugs approved by the United States Food and Drug Administration in the previous five (5) calendar years;
(w) "Wholesale acquisition cost" means the wholesale acquisition cost of the drug as defined in 42 USCยง 1395w-3a(c)(6)(B).
(g) The name of each of the drug manufacturer's drugs that lost patent exclusivity in the United States in the previous five (5) calendar years;
PAGE 61123 SECTION 3.
and (h) A concise statement of rationale regarding the factor or factors that caused the increase in the wholesale acquisition cost, such as raw ingredient shortage or increase in pharmacy benefit manager's or PSAO's rebates.
Section 73-21-155, Mississippi Code of 1972, is amended as follows:
(2) The quality and types of information and data a drug manufacturer submits to the board pursuant to this section must be the same as the quality and types of information and data the drug manufacturer includes in the drug manufacturer's annual consolidated report on the Securities and Exchange Commission Form 10-K or any other public disclosure.
A drug manufacturer shall notify the board in writing if the drug manufacturer is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D Program.
(3) The notice must include a concise statement of rationale regarding the factor or factors that caused the new drug to exceed the Medicare Part D Program price.
The drug manufacturer shall provide the written notice within three (3) calendar days following the release of the drug in the commercial market.
A H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 5(ENK\JAB) drug manufacturer may make the notification pending approval by the United States Food and Drug Administration if commercial availability is expected within three (3) calendar days following the approval.
(4) On or before October 1st of each year, a pharmacy benefit manager or PSAO providing services for a health care plan shall file a report with the board.
The report must contain the following information for the previous state fiscal year:
(a) The aggregated rebates, fees, price protection payments and any other payments collected from each drug manufacturer;
(b) The aggregated dollar amount of rebates, price protection payments, fees, and any other payments collected from each drug manufacturer which were passed to health insurers;
(c) The aggregated fees, price concessions, penalties, effective rates, and any other financial incentive collected from pharmacies which were passed to enrollees at the point of sale;
(d) The aggregated dollar amount of rebates, price protection payments, fees, and any other payments collected from drug manufacturers which were retained as revenue by the pharmacy benefit manager or PSAO;
and (e) The aggregated rebates passed on to employers.
(5) Reports submitted by pharmacy benefit managers and PSAOs under this section may not disclose the identity of a specific health benefit plan or enrollee, the identity of a drug H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 6(ENK\JAB) manufacturer, the prices charged for specific drugs or classes of drugs, or the amount of any rebates or fees provided for specific drugs or classes of drugs.
(6) On or before October 1st of each year, each health insurer shall submit a report to the board.
The report must contain the following information for the previous two (2) calendar years:
(a) Names of the twenty-five (25) most frequently prescribed drugs across all plans;
(b) Names of the twenty-five (25) prescription drugs dispensed with the highest dollar spent in terms of gross revenue;
(c) Percent of increase in annual net spending for prescription drugs across all plans;
(d) Percent of increase in premiums which is attributable to prescription drugs across all plans;
(e) Percentage of specialty drugs with utilization management requirements across all plans;
and (f) Premium reductions attributable to specialty drug utilization management.
(7) A report submitted by a health insurer may not disclose the identity of a specific health benefit plan or the prices charged for specific prescription drugs or classes of prescription drugs.
H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 7(ENK\JAB) (8) The provisions of this section shall apply to the pharmacy benefit manager or PSAO of the Mississippi State and School Employees Health Insurance Plan.
SECTION 4.
(1) The board shall develop a website to publish information the board receives under this chapter.
The board shall make the website available on the board's website with a dedicated link prominently displayed on the home page, or by a separate, easily identifiable Internet address.
(2) Within sixty (60) days of receipt of reported information under this chapter, the board shall publish the reported information on the website developed under this section.
The information the board publishes may not disclose or tend to disclose trade secrets, proprietary, commercial, financial, or confidential information of any pharmacy, pharmacy benefit manager, PSAO, drug wholesaler, or hospital.
(3) The board may adopt rules to implement this chapter.
The board shall develop forms that must be used for reporting required under this chapter.
The board may contract for services to implement this chapter.
(4) A report received by the board shall not be subject to the provisions of the federal Freedom of Information Act or the Mississippi Public Records Act and shall not be released by the board unless subject to an order from a court of competent jurisdiction.
The board shall destroy or delete or cause to be destroyed or deleted all such information thirty (30) days after H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 8(ENK\JAB) the board determines that the information is no longer necessary or useful.
(5) The provisions of this section shall apply to the pharmacy benefit manager and PSAO of the Mississippi State and School Employees Health Insurance Plan.
SECTION 5.
(1) Pharmacy benefit managers and PSAOs shall also identify to the board any ownership affiliation of any kind with any pharmacy which, either directly or indirectly, through one or more intermediaries:
(a) Has an investment or ownership interest in a pharmacy benefit manager or PSAO holding a certificate of authority;
(b) Shares common ownership with a pharmacy benefit manager or PSAO holding a certificate of authority in this state;
or (c) Has an investor or a holder of an ownership interest which is a pharmacy benefit manager or PSAO holding a certificate of authority issued in this state.
(2) A pharmacy benefit manager or PSAO shall report any change in information required by this act to the board in writing within sixty (60) days after the change occurs.
(3) The provisions of this section shall apply to the pharmacy benefit manager and PSAO of the Mississippi State and School Employees Health Insurance Plan.
H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 9(ENK\JAB) SECTION 6.
Every pharmacy benefit manager and PSAO shall disclose to the plan sponsor or employer one hundred percent (100%) of all rebates and other payments that the pharmacy benefit manager or PSAO receives directly or indirectly from pharmaceutical manufacturers and/or rebate aggregators in connection with claims administered on behalf of the plan sponsor or employer and the recipients of such rebates.
In addition, a pharmacy benefit manager or PSAO shall report annually to each plan sponsor or employer the aggregate amount of all rebates and other payments and the recipients of such rebates.
The provisions of this section shall apply to the pharmacy benefit manager and PSAO of the Mississippi State and School Employees Health Insurance Plan.
SECTION 7.
(1) The board may impose a monetary penalty on a pharmacy benefit manager, a pharmacy benefit manager affiliate or PSAO for noncompliance with the provisions of Sections 1 through 6 of this act, in amounts of not less than One Thousand Dollars ($1,000.00) per violation and not more than Twenty-five Thousand Dollars ($25,000.00) per violation.
The board shall prepare a record entered upon its minutes that states the basic facts upon which the monetary penalty was imposed.
(2) For the purposes of conducting investigations, the board may conduct examinations of a pharmacy benefit manager or PSAO and may also issue subpoenas to any individual, pharmacy, pharmacy H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 10(ENK\JAB) benefit manager, PSAO or any other entity having documents or records that it deems relevant to the investigation.
(3) The board may assess a monetary penalty for those reasonable costs that are expended by the board in the investigation and conduct of a proceeding if the board imposes a monetary penalty under subsection (1) of this section.
A monetary penalty assessed and levied under this section shall be paid to the board by the licensee, registrant or permit holder upon the expiration of the period allowed for appeal of penalties in the same manner as provided under Section 73-21-101, or may be paid sooner if the licensee, registrant or permit holder elects.
(4) When payment of a monetary penalty assessed and levied by the board against a licensee, registrant or permit holder in accordance with this section is not paid by the licensee, registrant or permit holder when due under this section, the board shall have the power to institute and maintain proceedings in its name for enforcement of payment in the chancery court of the county and judicial district of residence of the licensee, registrant or permit holder, or if the licensee, registrant or permit holder is a nonresident of the State of Mississippi, in the Chancery Court of the First Judicial District of Hinds County, Mississippi.
When those proceedings are instituted, the board shall certify the record of its proceedings, together with all documents and evidence, to the chancery court and the matter shall be heard in due course by the court, which shall review the record H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 11(ENK\JAB) and make its determination thereon in the same manner as provided under Section 73-21-101.
The hearing on the matter may, in the discretion of the chancellor, be tried in vacation.
(5) (a) The board may conduct audits to ensure compliance with the provisions of Sections 1 through 6 of this act.
In conducting audits, the board is empowered to request production of documents pertaining to compliance with the provisions of Sections 1 through 6 of this act, and documents so requested shall be produced within seven (7) days of the request unless extended by the board or its duly authorized staff.
(b) If, after the conclusion of the audit, the pharmacy benefit manager or PSAO was found to be in compliance with all of the requirements of Sections 1 through 6 of this act, then the board shall pay the costs of the audit.
However, if the pharmacy benefit manager or PSAO was not in compliance with all or a part of Sections 1 through 6 of this act, then the pharmacy benefit manager or PSAO being audited shall pay all costs of such audit.
The cost of the audit examination shall be deposited into a special fund and shall be used by the board, upon appropriation of the Legislature, to support the operations of the board relating to the auditing of pharmacy benefit managers or PSAOs.
(c) The board is authorized to hire independent consultants to conduct appeal audits of a pharmacy benefit manager or PSAO and expend funds collected under this section to pay the cost of performing audit services.
H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 12(ENK\JAB) (6) The provisions of this section shall apply to the pharmacy benefit manager and PSAO of the Mississippi State and School Employees Health Insurance Plan.
SECTION 8.
(1) Retaliation is prohibited.
(a) A pharmacy benefit manager or PSAO may not retaliate against a pharmacist or pharmacy based on the pharmacist's or pharmacy's exercise of any right or remedy under this chapter.
Retaliation prohibited by this section includes, but is not limited to:
(i) Terminating or refusing to renew a contract with the pharmacist or pharmacy;
(ii) Subjecting the pharmacist or pharmacy to an increased frequency of audits, number of claims audited, or amount of monies for claims audited;
or (iii) Failing to promptly pay the pharmacist or pharmacy any money owed by the pharmacy benefit manager or PSAO to the pharmacist or pharmacy.
(b) For the purposes of this section, a pharmacy benefit manager or PSAO is not considered to have retaliated against a pharmacy if the pharmacy benefit manager or PSAO:
(i) Takes an action in response to a credible allegation of fraud against the pharmacist or pharmacy;
and (ii) Provides reasonable notice to the pharmacist or pharmacy of the allegation of fraud and the basis of the allegation before initiating an action.
H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 13(ENK\JAB) (2) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO shall not penalize or retaliate against a pharmacist, pharmacy or pharmacy employee for exercising any rights under this chapter, initiating any judicial or regulatory actions or discussing or disclosing information pertaining to an agreement with a pharmacy benefit manager, a pharmacy benefit manager affiliate or PSAO when testifying or otherwise appearing before any governmental agency, legislative member or body or any judicial authority.
(3) The provisions of this section shall apply to the pharmacy benefit manager and PSAO of the Mississippi State and School Employees Health Insurance Plan.
SECTION 9.
Section 73-21-155, Mississippi Code of 1972, is brought forward as follows:
H.
(2) Pharmacy benefit managers, their agents and other parties responsible for reimbursement for prescription drugs and other products and supplies shall be required to update the nationally recognized reference prices or amounts used for calculation of reimbursement for prescription drugs and other products and supplies no less than every three (3) business days.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 14(ENK\JAB) (2) Pharmacy benefit managers, their agents and other parties responsible for reimbursement for prescription drugs and other products and supplies shall be required to update the nationally recognized reference prices or amounts used for calculation of reimbursement for prescription drugs and other products and supplies no less than every three (3) business days.
Benefits due under the plan and claims are overdue if not paid within seven (7) days or thirty-five (35) days, whichever is applicable, after the pharmacy benefit manager receives a clean claim containing necessary information essential for the pharmacy benefit manager to administer preexisting condition, coordination of benefits and subrogation provisions under the plan sponsor's health insurance plan.
Benefits due under the plan and claims are overdue if not paid within seven (7) days or PAGE 71123 thirty-five (35) days, whichever is applicable, after the pharmacy benefit manager receives a clean claim containing necessary information essential for the pharmacy benefit manager to administer preexisting condition, coordination of benefits and subrogation provisions under the plan sponsor's health insurance plan.
A "clean claim" means a claim received by any pharmacy benefit manager for adjudication and which requires no further information, adjustment or alteration by the pharmacist or pharmacies or the insured in order to be processed and paid by the pharmacy benefit manager.
A "clean claim" means a * * * completed billing instrument, paper or electronic, received by a pharmacy benefit manager from a pharmacist or pharmacies or the insured, which is accepted and payment remittance advice is provided by the pharmacy benefit manager.
A claim is clean if it has no defect or impropriety, including any lack of substantiating documentation, or particular circumstance requiring special treatment that H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 15(ENK\JAB) prevents timely payment from being made on the claim under this subsection.
if the pharmacist or pharmacy does not submit the claim on behalf of the insured, then a claim is not clean when submitted more than thirty (30) days after the date of billing by the pharmacist or pharmacy to the insured.
if the pharmacist or pharmacy does not submit the claim on behalf of the insured, then a claim is not clean when submitted more than thirty PAGE 81123 (30) days after the date of billing by the pharmacist or pharmacy to the insured.
(c) Not later than seven (7) days after the date the pharmacy benefit manager actually receives an electronic claim, the pharmacy benefit manager shall pay the appropriate benefit in full, or any portion of the claim that is clean, and notify the pharmacist or pharmacy (where the claim is owed to the pharmacist H.
(c) Not later than seven (7) days after the date the pharmacy benefit manager actually receives an electronic claim, the pharmacy benefit manager shall pay the appropriate benefit in full, or any portion of the claim that is clean, and notify the pharmacist or pharmacy (where the claim is owed to the pharmacist or pharmacy) of the reasons why the claim or portion thereof is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 16(ENK\JAB) or pharmacy) of the reasons why the claim or portion thereof is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean.
(4) If the board finds that any pharmacy benefit manager, agent or other party responsible for reimbursement for prescription drugs and other products and supplies has not paid ninety-five percent (95%) of clean claims as defined in subsection (3) of this section received from all pharmacies in a calendar quarter, he shall be subject to administrative penalty of not more than Twenty-five Thousand Dollars ($25,000.00) to be assessed by the State Board of Pharmacy.
(4) If the board finds that any pharmacy benefit manager, agent or other party responsible for reimbursement for prescription drugs and other products and supplies has not paid ninety-five percent (95%) of clean claims as defined in subsection PAGE 91123 (3) of this section received from all pharmacies in a calendar quarter, he shall be subject to administrative penalty of not more than Twenty-five Thousand Dollars ($25,000.00) to be assessed by the State Board of Pharmacy.
The board may contract H.
The board may contract with qualified impartial outside sources to assist in examinations to determine compliance.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 17(ENK\JAB) with qualified impartial outside sources to assist in examinations to determine compliance.
(d) Any pharmacy benefit manager and a pharmacy may enter into an express written agreement containing timely claim payment provisions which differ from, but are at least as stringent as, the provisions set forth under subsection (3) of this section, and in such case, the provisions of the written agreement shall govern the timely payment of claims by the pharmacy benefit manager to the pharmacy.
(d) Any pharmacy benefit manager and a pharmacy may enter into an express written agreement containing timely claim PAGE 10123 payment provisions which differ from, but are at least as stringent as, the provisions set forth under subsection (3) of this section, and in such case, the provisions of the written agreement shall govern the timely payment of claims by the pharmacy benefit manager to the pharmacy.
If the express written H.
If the express written agreement is silent as to any interest penalty where claims are not paid in accordance with the agreement, the interest penalty provision of subsection (4)(c) of this section shall apply.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 18(ENK\JAB) agreement is silent as to any interest penalty where claims are not paid in accordance with the agreement, the interest penalty provision of subsection (4)(c) of this section shall apply.
(5) (a) For purposes of this subsection (5), "network pharmacy" means a licensed pharmacy in this state that has a contract with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate.
(5) (a) For purposes of this subsection (5), "network pharmacy" means a * * * pharmacy licensed by the board and provides pharmacy services to Mississippi consumers and has a contract with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate.
(b) The State Board of Pharmacy shall adopt rules and regulations necessary to implement and ensure compliance with this subsection, including, but not limited to, rules and regulations that address access to pharmacy services in rural or underserved areas in cases where a network pharmacy or pharmacist declines to provide a drug or service under paragraph (a) of this subsection.
(b) The State Board of Pharmacy shall adopt rules and regulations necessary to implement and ensure compliance with this subsection, including, but not limited to, rules and regulations that address access to pharmacy services in rural or underserved PAGE 11123 areas in cases where a network pharmacy or pharmacist declines to provide a drug or service under paragraph (a) of this subsection.
H.
(6) A pharmacy benefit manager shall not directly or indirectly retroactively deny or reduce a claim or aggregate of claims after the claim or aggregate of claims has been adjudicated.
B.
SECTION 4.
No.
Section 73-21-156, Mississippi Code of 1972, is amended as follows:
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 19(ENK\JAB) (6) A pharmacy benefit manager shall not directly or indirectly retroactively deny or reduce a claim or aggregate of claims after the claim or aggregate of claims has been adjudicated.
SECTION 10.
Section 73-21-156, Mississippi Code of 1972, is brought forward as follows:
(vii) Wholesale acquisition cost;
PAGE 12123 (vii) Wholesale acquisition cost;
and (viii) Any other term that a pharmacy benefit manager or a health care insurer may use to establish H.
and (viii) Any other term that a pharmacy benefit manager or a health care insurer may use to establish reimbursement rates to a pharmacist or pharmacy for pharmacist services.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 20(ENK\JAB) reimbursement rates to a pharmacist or pharmacy for pharmacist services.
(a) If the drug is a generic equivalent drug product as defined in 73-21-73, shall be listed as therapeutically equivalent and pharmaceutically equivalent "A" or "B" rated in the United States Food and Drug Administration's most recent version of the "Orange Book" or "Green Book" or have an NR or NA rating by Medi-Span, Gold Standard, or a similar rating by a nationally recognized reference approved by the board;
(a) If the drug is a generic equivalent drug product as defined in Section 73-21-73, shall be listed as therapeutically equivalent and pharmaceutically equivalent "A" or "B" rated in the United States Food and Drug Administration's most recent version of the "Orange Book" or "Green Book" or have an NR or NA rating by Medi-Span, Gold Standard, or a similar rating by a nationally recognized reference approved by the board;
and H.
and PAGE 13123 (c) Provide a process for each pharmacy subject to the maximum allowable cost list to receive prompt notification of an update to the maximum allowable cost list.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 21(ENK\JAB) (c) Provide a process for each pharmacy subject to the maximum allowable cost list to receive prompt notification of an update to the maximum allowable cost list.
(a) Provide a reasonable administrative appeal procedure to allow pharmacies to challenge a maximum allowable cost list and reimbursements made under a maximum allowable cost list for a specific drug or drugs as:
(a) Provide a reasonable administrative appeal procedure to allow pharmacies to challenge * * * reimbursements made * * * for a specific drug or drugs as:
(i) A dedicated telephone number, email address and website for the purpose of submitting administrative appeals;
(i) A * * * direct telephone number, email address and website for the purpose of submitting administrative appeals;
(ii) The ability to submit an administrative appeal directly to the pharmacy benefit manager regarding the pharmacy benefit management plan or through a pharmacy service administrative organization;
(ii) The website of the pharmacy benefit manager shall include easily accessible administrative appeal instructions, including listing any required information to be submitted by pharmacies for the purpose of submitting administrative appeals;
and (iii) A period of less than thirty (30) business days to file an administrative appeal.
( * * *iii) The ability to submit an administrative appeal or a claim appeal report for multiple claims directly to the pharmacy benefit manager * * * or through a * * * PSAO;
(c) The pharmacy benefit manager shall respond to the challenge under paragraph (a) of this subsection (4) within thirty (30) business days after receipt of the challenge.
and ( * * *iv) A period of no less than thirty (30) * * * days to file an administrative appeal.
H.
PAGE 14123 (c) The pharmacy benefit manager shall respond to the challenge under paragraph (a) of this subsection (4) within thirty (30) * * * days after receipt of the challenge.
B.
(d) If a challenge is made under paragraph (a) of this subsection (4), the pharmacy benefit manager shall within thirty (30) * * * days after receipt of the challenge either:
No.
(i) * * * Uphold the appeal * * * and adjust the reimbursement paid to the pharmacist or pharmacy to no less than the pharmacy acquisition cost, as documented on the pharmacistโ€™s or pharmacyโ€™s billing invoice, or as provided in the claim appeal report, and make the * * * adjustment effective for each * * * pharmacy that filed a claim for that NDC on the same day of service and was reimbursed at or below the challenged rate;
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 22(ENK\JAB) (d) If a challenge is made under paragraph (a) of this subsection (4), the pharmacy benefit manager shall within thirty (30) business days after receipt of the challenge either:
or (ii) * * * Deny the appeal * * * and provide the * * * reason for the denial in writing to the pharmacist or pharmacy.
(i) If the appeal is upheld:
(e) The board may adopt rules and regulations necessary to ensure compliance with this subsection.
1.
(5) A pharmacy benefit manager shall not deny an appeal submitted pursuant to subsection (4) of this section based upon an existing contract with the pharmacy that provides for a reimbursement rate lower than the pharmacy acquisition cost.
Make the change in the maximum allowable cost list payment to at least the pharmacy acquisition cost;
(6) A pharmacy or pharmacist that belongs to a PSAO shall be provided a true and correct copy of any contract and contract amendment that the PSAO enters into with a pharmacy benefit PAGE 15123 manager or third-party payer on the pharmacy's or pharmacist's behalf.
2.
( * * *7) * * * A pharmacy benefit manager shall not reimburse a pharmacy or pharmacist in the state an amount less than the amount that the pharmacy benefit manager reimburses a pharmacy benefit manager affiliate for providing the same * * * drug or drugs.
Permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question;
* * * The reimbursement amount for such drug or drugs shall be calculated on a per unit basis based on the same brand and generic product identifier or brand and generic code number.
3.
SECTION 5.
Provide the National Drug Code that the increase or change is based on to the pharmacy or pharmacist;
Section 73-21-157, Mississippi Code of 1972, is amended as follows:
and 4.
73-21-157.
Make the change under item 1 of this subparagraph (i) effective for each similarly situated pharmacy as defined by the payor subject to the maximum allowable cost list;
(1) Before beginning to do business as a pharmacy benefit manager or PSAO, a pharmacy benefit manager or PSAO shall obtain a license to do business from the board.
or (ii) If the appeal is denied, provide the challenging pharmacy or pharmacist the National Drug Code and the name of the national or regional pharmaceutical wholesalers operating in Mississippi that have the drug currently in stock at a price below the maximum allowable cost as listed on the maximum allowable cost list;
To obtain a license, the applicant shall submit an application to the board on a form to be prescribed by the board.
or (iii) If the National Drug Code provided by the pharmacy benefit manager is not available below the pharmacy acquisition cost from the pharmaceutical wholesaler from whom the pharmacy or pharmacist purchases the majority of prescription drugs for resale, then the pharmacy benefit manager shall adjust H.
This license shall be renewed annually.
B.
(2) When applying for a license or renewal of a license, each pharmacy benefit manager * * * or PSAO shall file * * * with the board * * *:
No.
(a) A copy of a certified audit report, if the pharmacy benefit manager has been audited by a certified public accountant within the last twenty-four (24) months;
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 23(ENK\JAB) the maximum allowable cost as listed on the maximum allowable cost list above the challenging pharmacy's pharmacy acquisition cost and permit the pharmacy to reverse and rebill each claim affected by the inability to procure the drug at a cost that is equal to or less than the previously challenged maximum allowable cost.
or ( * * *b) If the pharmacy benefit manager has not been audited in the last twenty-four (24) months, a financial statement PAGE 16123 of the organization, including its balance sheet and income statement for the preceding year which shall be verified by at least two (2) principal officers;
(5) (a) A pharmacy benefit manager shall not reimburse a pharmacy or pharmacist in the state an amount less than the amount that the pharmacy benefit manager reimburses a pharmacy benefit manager affiliate for providing the same pharmacist services.
and ( * * *c) Any other information relating to the operations of the pharmacy benefit manager required by the board * * *.
(b) The amount shall be calculated on a per unit basis based on the same brand and generic product identifier or brand and generic code number.
( * * *3) (a) Any information required to be submitted to the board pursuant to licensure application that is considered proprietary by a pharmacy benefit manager or PSAO shall be marked as confidential when submitted to the board.
All such information shall not be subject to the provisions of the federal Freedom of Information Act or the Mississippi Public Records Act and shall not be released by the board unless subject to an order from a court of competent jurisdiction.
The board shall destroy or delete or cause to be destroyed or deleted all such information thirty (30) days after the board determines that the information is no longer necessary or useful.
(b) Any person who knowingly releases, causes to be released or assists in the release of any such information shall be subject to a monetary penalty imposed by the board in an amount not exceeding Fifty Thousand Dollars ($50,000.00) per violation.
When the board is considering the imposition of any penalty under this paragraph (b), it shall follow the same policies and procedures provided for the imposition of other sanctions in the Pharmacy Practice Act.
Any penalty collected under this paragraph (b) shall be deposited into the special fund of the board and used PAGE 17123 to support the operations of the board relating to the regulation of pharmacy benefit managers.
(c) All employees of the board who have access to the information described in paragraph (a) of this subsection shall be fingerprinted, and the board shall submit a set of fingerprints for each employee to the Department of Public Safety for the purpose of conducting a criminal history records check.
If no disqualifying record is identified at the state level, the Department of Public Safety shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history records check.
( * * *4) * * * The board may waive the requirements for filing financial information for the pharmacy benefit manager if an affiliate of the pharmacy benefit manager is already required to file such information under current law with the Commissioner of Insurance and allow the pharmacy benefit manager to file a copy of documents containing such information with the board in lieu of the statement required by this section.
( * * *5) The expense of administering this section shall be assessed annually by the board against all pharmacy benefit managers and PSAOs operating in this state.
( * * *6) A pharmacy benefit manager, PSAO or third-party payor * * * shall not require pharmacy accreditation standards or * * * certification requirements inconsistent with, more stringent than, or in addition to federal and state requirements for licensure as a pharmacy in this state.
PAGE 18123 SECTION 6.
The following shall be codified as Section 73-21-158, Mississippi Code of 1972:
73-21-158.
(1) No pharmacy benefit manager, PSAO, carrier or health benefit plan may, either directly or through an intermediary, agent or affiliate engage in, facilitate or enter into a contract with another person involving spread pricing in this state.
(2) A pharmacy benefit manager or PSAO contract with a carrier or health benefit plan entered into, renewed or amended on or after the effective date of this act must:
(a) Specify all forms of revenue, including pharmacy benefit management or PSAO fees, to be paid by the carrier or health benefit plan to the pharmacy benefit manager or PSAO;
and (b) Acknowledge that spread pricing is not permitted in accordance with this section.
(3) Subsections (1) and (2) of this section shall not apply to self-insured plans.
(4) Every pharmacy benefit manager and PSAO shall disclose to the plan sponsor or employer one hundred percent (100%) of all rebates and other payments that the pharmacy benefit manager or PSAO receives directly or indirectly from pharmaceutical manufacturers and/or rebate aggregators in connection with claims administered on behalf of the plan sponsor or employer and the recipients of such rebates.
In addition, a pharmacy benefit manager or PSAO shall report annually to each plan sponsor or employer the aggregate amount of all rebates and PAGE 19123 other payments and the recipients of such rebates.
(5) A pharmacy benefit manager or third-party payer shall not charge or cause a patient to pay an amount that exceeds the total amount retained by the pharmacy.
(6) This section shall stand repealed on June 30, 2028.
SECTION 7.
Section 73-21-161, Mississippi Code of 1972, is amended as follows:
73-21-161.
(1) As used in this section, the term " * * *steering" means:
(a) Directing, ordering * * *, or requiring a patient to use a specific affiliate pharmacy * * * or pharmacies, for the purpose of filling a prescription or receiving services or other care from a pharmacist;
(b) Offering or implementing health insurance plan designs that require * * * a beneficiary to * * * utilize an affiliate pharmacy or pharmacies, or that increases costs to a patient, including requiring a patient to pay the full cost for a prescription drug when such patient chooses not to use a pharmacy benefit manager affiliate pharmacy;
* * * (c) * * * Advertising, marketing, or * * * promoting an affiliate * * * pharmacy or pharmacies, over another in-network pharmacy;
(d) Creating any network or engaging in any practice, including accreditation or credentialing standards, day supply limitations or delivery methods limitations, that exclude an PAGE 20123 in-network pharmacy or restrict an in-network pharmacy from filling a prescription for a prescription drug;
or (e) Directly or indirectly engaging in any practice that attempts to influence or induce a pharmaceutical manufacturer to limit the distribution of a prescription drug to a small number of pharmacies or certain types of pharmacies, or to restrict distribution of such drug to nonaffiliate pharmacies.
The term " * * *steering" does not include a pharmacy's inclusion by a pharmacy benefit manager or pharmacy benefit manager affiliate in communications to patients, including patient and prospective patient specific communications, regarding network pharmacies and prices, provided that the pharmacy benefit manager or a pharmacy benefit manager affiliate includes information regarding eligible nonaffiliate pharmacies in those communications and the information provided is accurate.
(2) A pharmacy, pharmacy benefit manager, or pharmacy benefit manager affiliate licensed or operating in Mississippi shall be prohibited from:
(a) * * * Steering;
(b) Transferring or sharing records relative to prescription information containing patient identifiable and prescriber identifiable data to or from a pharmacy benefit manager affiliate for any commercial purpose;
however, nothing in this section shall be construed to prohibit the exchange of prescription information between a pharmacy and its affiliate for the limited purposes of pharmacy reimbursement;
formulary PAGE 21123 compliance;
pharmacy care;
public health activities otherwise authorized by law;
or utilization review by a health care provider;
or (c) Presenting a claim for payment to any individual, third-party payor, affiliate, or other entity for a service furnished * * * by steering from * * * a pharmacy benefit manager or pharmacy benefit manager affiliate * * *;
or (d) Interfering with the patient's right to choose the patient's pharmacy or provider of choice, including inducement, required referrals or offering financial or other incentives or measures that would constitute a violation of Section 83-9-6.
(3) This section shall not be construed to prohibit a pharmacy from entering into an agreement with a pharmacy benefit manager or pharmacy benefit manager affiliate to provide pharmacy care to patients, provided that neither the pharmacy * * * nor the pharmacy benefit manager or pharmacy benefit manager affiliate violate subsection (2) of this section and the pharmacy provides the disclosures required in subsection (1) of this section.
* * * ( * * *4) In addition to any other remedy provided by law, a violation of this section by a pharmacy shall be grounds for disciplinary action by the board under its authority granted in this chapter.
( * * *5) A pharmacist who fills a prescription that violates subsection (2) of this section shall not be liable under this section.
PAGE 22123 (6) This section shall not apply to facilities licensed to fill prescriptions solely for employees of a plan sponsor or employer.
SECTION 8.
The following shall be codified as Section 73-21-162, Mississippi Code of 1972:
73-21-162.
(1) Retaliation is prohibited.
(a) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO shall not retaliate against a pharmacist or pharmacy based on the pharmacist's or pharmacy's exercise of any right or remedy under this chapter.
Retaliation prohibited by this section includes, but is not limited to:
(i) Terminating or refusing to renew a contract with the pharmacist or pharmacy;
(ii) Subjecting the pharmacist or pharmacy to an increased frequency of audits, number of claims audited or amount of monies for claims audited;
or (iii) Failing to promptly pay the pharmacist or pharmacy any money owed by the pharmacy benefit manager to the pharmacist or pharmacy.
(b) For the purposes of this section, a pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO is not considered to have retaliated against a pharmacy if the pharmacy benefit manager:
(i) Takes an action in response to a credible allegation of fraud against the pharmacist or pharmacy;
and PAGE 23123 (ii) Provides reasonable notice to the pharmacist or pharmacy of the allegation of fraud and the basis of the allegation before initiating an action.
(2) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO shall not penalize or retaliate against a pharmacist, pharmacy or pharmacy employee for exercising any rights under this chapter, initiating any judicial or regulatory actions or discussing or disclosing information pertaining to an agreement with a pharmacy benefit manager or a pharmacy benefit manager affiliate when testifying or otherwise appearing before any governmental agency, legislative member or body or any judicial authority.
SECTION 9.
Section 73-21-163, Mississippi Code of 1972, is amended as follows:
73-21-163.
(1) Whenever the board has reason to believe that a pharmacy benefit manager * * *, pharmacy benefit manager affiliate or PSAO is using, has used, or is about to use any method, act or practice prohibited in * * * this act and that proceedings would be in the public interest, it may bring an action in the name of the board against the pharmacy benefit manager * * *, pharmacy benefit manager affiliate or PSAO to restrain by temporary or permanent injunction the use of such method, act or practice.
The action shall be brought in the Chancery Court of the First Judicial District of Hinds County, Mississippi.
The court is authorized to issue temporary or PAGE 24123 permanent injunctions to restrain and prevent violations of * * * this act and such injunctions shall be issued without bond.
(2) The board may impose a monetary penalty on a pharmacy benefit manager * * *, or a pharmacy benefit manager affiliate or PSAO for noncompliance with the provisions of * * * this act, in amounts of not less than One Thousand Dollars ($1,000.00) per violation and not more than Twenty-five Thousand Dollars ($25,000.00) per violation.
Each day a violation continues for the same brand or generic product identifier or brand or generic code number is a separate violation.
Each day that a pharmacy benefit manager or PSAO does business in this state without a license is deemed a separate violation.
The board shall prepare a record entered upon its minutes that states the basic facts upon which the monetary penalty was imposed.
Any penalty collected under this subsection (2) shall be deposited into the special fund of the board.
(3) For the purposes of conducting investigations, the board, through its executive director, may conduct audits and examinations of a pharmacy benefit manager or PSAO and may also issue subpoenas to any individual, pharmacy, pharmacy benefit manager, PSAO or any other entity having documents or records that it deems relevant to the investigation.
( * * *4) The board may assess a monetary penalty for those reasonable costs that are expended by the board in the investigation and conduct of a proceeding if the board imposes a monetary penalty under subsection (2) of this section.
A monetary PAGE 25123 penalty assessed and levied under this section shall be paid to the board by the licensee, registrant or permit holder upon the expiration of the period allowed for appeal of those penalties under Section 73-21-101, or may be paid sooner if the licensee, registrant or permit holder elects.
Any penalty collected by the board under this subsection ( * * *4) shall be deposited into the special fund of the board.
( * * *5) When payment of a monetary penalty assessed and levied by the board against a licensee, registrant or permit holder in accordance with this section is not paid by the licensee, registrant or permit holder when due under this section, the board shall have the power to institute and maintain proceedings in its name for enforcement of payment in the chancery court of the county and judicial district of residence of the licensee, registrant or permit holder, or if the licensee, registrant or permit holder is a nonresident of the State of Mississippi, in the Chancery Court of the First Judicial District of Hinds County, Mississippi.
When those proceedings are instituted, the board shall certify the record of its proceedings, together with all documents and evidence, to the chancery court and the matter shall be heard in due course by the court, which shall review the record and make its determination thereon in accordance with the provisions of Section 73-21-101.
The hearing on the matter may, in the discretion of the chancellor, be tried in vacation.
PAGE 26123 (6) (a) The board may conduct audits to ensure compliance with the provisions of this act.
In conducting audits, the board is empowered to request production of documents pertaining to compliance with the provisions of this act, and documents so requested shall be produced within seven (7) days of the request unless extended by the board or its duly authorized staff.
(b) If, after the conclusion of the audit, the pharmacy benefit manager or PSAO was found to be in compliance with all of the requirements of this act, then the board shall pay the costs of the audit.
However, the pharmacy benefit manager or PSAO being audited shall pay all costs of such audit if such audit reveals any noncompliance with this act.
The cost of the audit examination shall be deposited into the special fund and shall be used by the board, upon appropriation of the Legislature, to support the operations of the board relating to the regulation of pharmacy benefit managers.
(c) The board is authorized to hire independent consultants to conduct audits of a pharmacy benefit manager and expend funds collected under this section to pay the cost of performing audit services.
( * * *7) The board shall develop and implement a uniform penalty policy that sets the minimum and maximum penalty for any given violation of * * * this act.
The board shall adhere to its uniform penalty policy except in those cases where the board specifically finds, by majority vote, that a penalty in excess of, or less than, the uniform penalty is appropriate.
That vote shall PAGE 27123 be reflected in the minutes of the board and shall not be imposed unless it appears as having been adopted by the board.
SECTION 10.
The following shall be codified as Section 73-21-165, Mississippi Code of 1972:
73-21-165.
(1) Each drug manufacturer shall submit a report to the board no later than the fifteenth day of January, April, July and October with the current wholesale acquisition cost information for the prescription drugs sold in or into the state by that drug manufacturer;
provided, however, the first report due under this subsection shall not be due until October 1, 2025.
(2) Not more than thirty (30) days after an increase in wholesale acquisition cost of forty percent (40%) or greater over the preceding five (5) calendar years or ten percent (10%) or greater in the preceding twelve (12) months for a prescription drug with a wholesale acquisition cost of Seventy Dollars ($70.00) or more for a manufacturer-packaged drug container, a drug manufacturer shall submit a report to the board.
The report must contain the following information:
(a) The name of the drug;
(b) Whether the drug is a brand name or a generic;
(c) The effective date of the change in wholesale acquisition cost;
(d) Aggregate, company-level research and development costs for the previous calendar year;
(e) Aggregate rebate amounts paid to each pharmacy benefit manager or PSAO for the previous calendar year;
PAGE 28123 (f) The name of each of the drug manufacturer's drugs approved by the United States Food and Drug Administration in the previous five (5) calendar years;
(g) The name of each of the drug manufacturer's drugs that lost patent exclusivity in the United States in the previous five (5) calendar years;
and (h) A concise statement of rationale regarding the factor or factors that caused the increase in the wholesale acquisition cost, such as raw ingredient shortage or increase in pharmacy benefit manager's or PSAO's rebates.
(3) A manufacturer's obligations under this section shall be fully satisfied by the submission of any information and data that a manufacturer includes in the manufacturer's annual consolidated report on Securities and Exchange Form 10-K or any other public disclosure.
A drug manufacturer shall notify the board in writing if the drug manufacturer is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D Program.
(4) The notice must include a concise statement of rationale regarding the factor or factors that caused the new drug to exceed the Medicare Part D Program price.
The drug manufacturer shall provide the written notice within three (3) calendar days following the release of the drug in the commercial market.
A drug manufacturer may make the notification pending approval by the United States Food and Drug Administration if commercial PAGE 29123 availability is expected within three (3) calendar days following the approval.
(5) On or before October 1st of each year, a pharmacy benefit manager or PSAO providing services for a health care plan shall file a report with the board.
The report must contain the following information for the previous state fiscal year:
(a) The aggregated rebates, fees, price protection payments, and any other payments collected from each drug manufacturer;
(b) The aggregated dollar amount of rebates, price protection payments, fees, and any other payments collected from each drug manufacturer which were passed to health insurers;
(c) The aggregated fees, price concessions, penalties, effective rates, and any other financial incentive collected from pharmacies which were passed to enrollees at the point of sale;
(d) The aggregated dollar amount of rebates, price protection payments, fees, and any other payments collected from drug manufacturers which were retained as revenue by the pharmacy benefit manager or PSAO;
and (e) The aggregated rebates passed on to employers.
(6) Reports submitted by pharmacy benefit managers and PSAOs under this section may not disclose the identity of a specific health benefit plan or enrollee, the identity of a drug manufacturer, the prices charged for specific drugs or classes of drugs, or the amount of any rebates or fees provided for specific drugs or classes of drugs.
PAGE 30123 (7) On or before October 1st of each year, each health insurer shall submit a report to the board.
The report must contain the following information for the previous two (2) calendar years:
(a) Names of the twenty-five (25) most frequently prescribed drugs across all plans;
(b) Names of the twenty-five (25) prescription drugs dispensed with the highest dollar spent in terms of gross revenue;
(c) Percent of increase in annual net spending for prescription drugs across all plans;
(d) Percent of increase in premiums which is attributable to prescription drugs across all plans;
(e) Percentage of specialty drugs with utilization management requirements across all plans;
and (f) Premium reductions attributable to specialty drug utilization management.
(8) A report submitted by a health insurer may not disclose the identity of a specific health benefit plan or the prices charged for specific prescription drugs or classes of prescription drugs.
(9) This section shall stand repealed on June 30, 2028.
Section 73-21-183, Mississippi Code of 1972, is brought forward as follows:
The following shall be codified as Section 73-21-167, Mississippi Code of 1972:
73-21-183.
73-21-167.
(1) The entity conducting an audit shall follow these procedures:
(1) The board shall develop a website to publish information the board receives under this chapter.
(a) The pharmacy contract must identify and describe in detail the audit procedures;
The board shall make the website available on the board's website with a PAGE 31123 dedicated link prominently displayed on the home page, or by a separate, easily identifiable Internet address.
(b) The entity conducting the on-site audit must give the pharmacy written notice at least two (2) weeks before conducting the initial on-site audit for each audit cycle, and the pharmacy shall have at least fourteen (14) days to respond to any desk audit requirements;
(2) Within sixty (60) days of receipt of reported information under this chapter, the board shall publish the reported information on the website developed under this section.
(c) The entity conducting the on-site or desk audit shall not interfere with the delivery of pharmacist services to a H.
The information the board publishes may not disclose or tend to disclose trade secrets, proprietary, commercial, financial or confidential information of any pharmacy, pharmacy benefit manager, PSAO, drug wholesaler, drug manufacturer or hospital.
B.
(3) The board may adopt rules to implement this chapter.
No.
The board shall develop forms that must be used for reporting required under this chapter.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 24(ENK\JAB) patient and shall utilize every effort to minimize inconvenience and disruption to pharmacy operations during the audit process;
The board may contract for services to implement this chapter.
(d) Any audit that involves clinical or professional judgment must be conducted by or in consultation with a pharmacist;
(4) A report received by the board shall not be subject to the provisions of the federal Freedom of Information Act or the Mississippi Public Records Act and shall not be released by the board unless subject to an order from a court of competent jurisdiction.
(e) Any clerical or record-keeping error, such as a typographical error, scrivener's error, or computer error, regarding a required document or record shall not constitute fraud;
The board shall destroy or delete or cause to be destroyed or deleted all such information thirty (30) days after the board determines that the information is no longer necessary or useful.
however, those claims may be subject to recoupment.
(5) This section shall stand repealed on June 30, 2028.
No such claim shall be subject to criminal penalties without proof of intent to commit fraud;
(f) A pharmacy may use the records of a hospital, physician, or other authorized practitioner of the healing arts for drugs or medicinal supplies written or transmitted by any means of communication for purposes of validating the pharmacy record with respect to orders or refills of a legend or narcotic drug;
(g) A finding of an overpayment or an underpayment may be a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs, except that recoupment shall be based on the actual overpayment or underpayment;
(h) A finding of an overpayment shall not include the dispensing fee amount unless a prescription was not dispensed;
H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 25(ENK\JAB) (i) Each pharmacy shall be audited under the same standards and parameters as other similarly situated pharmacies audited by the entity;
(j) The period covered by an audit may not exceed two (2) years from the date the claim was submitted to or adjudicated by a managed care company, nonprofit hospital or medical service organization, insurance company, third-party payor, pharmacy benefit manager, a health program administered by a department of the state or any entity that represents those companies, groups, or department;
(k) An audit may not be initiated or scheduled during the first five (5) calendar days of any month due to the high volume of prescriptions filled in the pharmacy during that time unless otherwise consented to by the pharmacy;
(l) Any prescription that complies with state law and rule requirements may be used to validate claims in connection with prescriptions, refills or changes in prescriptions;
(m) An exit interview that provides a pharmacy with an opportunity to respond to questions and comment on and clarify findings must be conducted at the end of an audit.
The time of the interview must be agreed to by the pharmacy;
(n) Unless superseded by state or federal law, auditors shall only have access to previous audit reports on a particular pharmacy conducted by the auditing entity for the same pharmacy benefits manager, health plan or insurer.
An auditing vendor H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 26(ENK\JAB) contracting with multiple pharmacy benefits managers or health insurance plans shall not use audit reports or other information gained from an audit on a particular pharmacy to conduct another audit for a different pharmacy benefits manager or health insurance plan;
(o) The parameters of an audit must comply with consumer-oriented parameters based on manufacturer listings or recommendations for the following:
(i) The day supply for eyedrops must be calculated so that the consumer pays only one (1) thirty-day copayment if the bottle of eyedrops is intended by the manufacturer to be a thirty-day supply;
(ii) The day supply for insulin must be calculated so that the highest dose prescribed is used to determine the day supply and consumer copayment;
(iii) The day supply for a topical product must be determined by the judgment of the pharmacist based upon the treated area;
(p) (i) Where an audit is for a specifically identified problem that has been disclosed to the pharmacy, the audit shall be limited to claims that are identified by prescription number;
(ii) For an audit other than described in subparagraph (i) of this paragraph (p), an audit shall be limited H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 27(ENK\JAB) to one hundred (100) individual prescriptions that have been randomly selected;
(iii) If an audit reveals the necessity for a review of additional claims, the audit shall be conducted on site;
(iv) Except for audits initiated under paragraph (i) of this subsection, an entity shall not initiate an audit of a pharmacy more than one (1) time in any quarter;
(r) A recoupment shall not be based on:
(i) Documentation requirements in addition to or exceeding requirements for creating or maintaining documentation prescribed by the State Board of Pharmacy;
or (ii) A requirement that a pharmacy or pharmacist perform a professional duty in addition to or exceeding professional duties prescribed by the State Board of Pharmacy;
(s) Except for Medicare claims, approval of drug, prescriber or patient eligibility upon adjudication of a claim shall not be reversed unless the pharmacy or pharmacist obtained the adjudication by fraud or misrepresentation of claim elements;
and (t) A commission or other payment to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped.
(2) The entity must provide the pharmacy with a written report of the audit and comply with the following requirements:
H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 28(ENK\JAB) (a) The preliminary audit report must be delivered to the pharmacy within one hundred twenty (120) days after conclusion of the audit, with a reasonable extension to be granted upon request;
(b) A pharmacy shall be allowed at least thirty (30) days following receipt of the preliminary audit report in which to produce documentation to address any discrepancy found during the audit, with a reasonable extension to be granted upon request;
(c) A final audit report shall be delivered to the pharmacy within one hundred eighty (180) days after receipt of the preliminary audit report or final appeal, as provided for in Section 73-21-185, whichever is later;
(d) The audit report must be signed by the auditor;
(e) Recoupments of any disputed funds, or repayment of funds to the entity by the pharmacy if permitted pursuant to contractual agreement, shall occur after final internal disposition of the audit, including the appeals process as set forth in Section 73-21-185.
If the identified discrepancy for an individual audit exceeds Twenty-five Thousand Dollars ($25,000.00), future payments in excess of that amount to the pharmacy may be withheld pending finalization of the audit;
(f) Interest shall not accrue during the audit period;
and H.
B.
No.
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 PAGE 29(ENK\JAB) (g) Each entity conducting an audit shall provide a copy of the final audit report, after completion of any review process, to the plan sponsor.
This act shall take effect and be in force from and after July 1, 2025, and Sections 1 through 8 shall stand repealed on June 30, 2028.
The following shall be codified as Section 73-21-169, Mississippi Code of 1972:
H.
PAGE 32123 73-21-169.
(1) Pharmacy benefit managers and PSAOs shall also identify to the board any ownership affiliation of any kind with any pharmacy which, either directly or indirectly, through one or more intermediaries:
(a) Has an investment or ownership interest in a pharmacy benefit manager or PSAO holding a certificate of authority;
(b) Shares common ownership with a pharmacy benefit manager or PSAO holding a certificate of authority in this state;
or (c) Has an investor or a holder of an ownership interest which is a pharmacy benefit manager or PSAO holding a certificate of authority issued in this state.
(2) A pharmacy benefit manager or PSAO shall report any change in information required by this act to the board in writing within sixty (60) days after the change occurs.
(3) This section shall stand repealed on June 30, 2028.
SECTION 13.
This act shall take effect and be in force from and after July 1, 2025.
Further, amend by striking the title in its entirety and inserting in lieu thereof the following:
AN ACT TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE NEW SECTIONS IN THE PHARMACY BENEFIT PROMPT PAY ACT;
TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE NEW TERMS AND REVISE THE DEFINITIONS OF EXISTING TERMS UNDER THE PHARMACY BENEFIT PROMPT PAY ACT;
TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO CONFORM DEFINITIONS FOR "CLEAN CLAIM" AND "NETWORK PHARMACY";
TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO PROVIDE A PAGE 33123 REASONABLE ADMINISTRATIVE APPEAL PROCEDURE TO ALLOW PHARMACIES TO CHALLENGE A REIMBURSEMENT FOR A SPECIFIC DRUG OR DRUGS AS BEING BELOW THE REIMBURSEMENT RATE REQUIRED BY THE PRECEDING PROVISION;
TO PROVIDE THAT IF THE APPEAL IS UPHELD, THE PHARMACY BENEFIT MANAGER SHALL MAKE THE CHANGE IN THE PAYMENT TO THE REQUIRED REIMBURSEMENT RATE;
TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE A PHARMACY SERVICES ADMINISTRATIVE ORGANIZATION (PSAO) TO BE LICENSED WITH THE MISSISSIPPI BOARD OF PHARMACY;
TO REQUIRE A PSAO TO PROVIDE TO A PHARMACY OR PHARMACIST A COPY OF ANY CONTRACT ENTERED INTO ON BEHALF OF THE PHARMACY OR PHARMACIST BY THE PSAO;
TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER, PSAO, CARRIER OR HEALTH PLAN FROM SPREAD PRICING;
TO AMEND SECTION 73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER OR PHARMACY BENEFIT MANAGER AFFILIATES FROM ORDERING A PATIENT TO USE A SPECIFIC PHARMACY OR PHARMACIES, INCLUDING AN AFFILIATE PHARMACY;
OFFERING OR IMPLEMENTING PLAN DESIGNS THAT PENALIZE A PATIENT WHEN A PATIENT CHOOSES NOT TO USE A PARTICULAR PHARMACY, INCLUDING AN AFFILIATE PHARMACY;
ADVERTISING OR PROMOTING A PHARMACY, INCLUDING AN AFFILIATE PHARMACY, OVER ANOTHER IN-NETWORK PHARMACY;
CREATING NETWORK OR ENGAGING IN PRACTICES THAT EXCLUDE AN IN-NETWORK PHARMACY;
ENGAGING IN A PRACTICE THAT ATTEMPTS TO LIMIT THE DISTRIBUTION OF A PRESCRIPTION DRUG TO CERTAIN PHARMACIES;
INTERFERING WITH THE PATIENT'S RIGHT TO CHOOSE THE PATIENT'S PHARMACY OR PROVIDER OF CHOICE;
TO PROVIDE THAT THIS SECTION DOES NOT APPLY TO FACILITIES LICENSED TO FILL PRESCRIPTIONS SOLELY FOR EMPLOYEES OF A PLAN SPONSOR OR EMPLOYER;
TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS (PSAOS) FROM PENALIZING OR RETALIATING AGAINST A PHARMACIST, PHARMACY OR PHARMACY EMPLOYEE FOR EXERCISING ANY RIGHTS UNDER THIS ACT, INITIATING ANY JUDICIAL OR REGULATORY ACTIONS, OR APPEARING BEFORE ANY GOVERNMENTAL AGENCY, LEGISLATIVE MEMBER OR BODY OR ANY JUDICIAL AUTHORITY;
TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE BOARD OF PHARMACY, FOR THE PURPOSES OF CONDUCTING INVESTIGATIONS, TO CONDUCT EXAMINATIONS OF A PHARMACY BENEFIT MANAGER OR PSAO AND TO ISSUE SUBPOENAS TO OBTAIN DOCUMENTS OR RECORDS THAT IT DEEMS RELEVANT TO THE INVESTIGATION;
TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE EACH DRUG MANUFACTURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES THE CURRENT WHOLESALE ACQUISITION COST;
TO REQUIRE SUCH ENTITIES TO PROVIDE THE BOARD OF PHARMACY WITH VARIOUS DRUG PRICING INFORMATION WITHIN A CERTAIN TIME;
TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO FILE A REPORT WITH THE BOARD OF PHARMACY;
TO REQUIRE EACH HEALTH INSURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES CERTAIN DRUG PRESCRIPTION INFORMATION;
TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD OF PHARMACY TO DEVELOP A WEBSITE TO PUBLISH INFORMATION RELATED TO THE ACT;
TO CREATE NEW SECTION 73-21-169, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO IDENTIFY PAGE 34123 OWNERSHIP AFFILIATION OF ANY KIND TO THE BOARD OF PHARMACY;
AND FOR RELATED PURPOSES.
SS36\HB1123A.2J Amanda White Secretary of the Senate H.
No.
1123 PAGE 35
1123 *HR31/R1411* ~ OFFICIAL ~ 25/HR31/R1411 ST:
Pharmacy benefit managers and pharmacy PAGE 30(ENK\JAB) services administrative organizations;
provide certain regulations for.