HB 24 — AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO COPAYMENT OR COINSURANCE FOR PRESCRIPTION DRUGS.

Bennett &HOUSE Sen.OF REPRESENTATIVES 150th GENERAL ASSEMBLY HOUSE AMENDMENT NO.

Delcollo1 Reps.TO HOUSE BILL NO.

Bentz,24 Bush,AMEND DorseyHouse Walker,Bill Heffernan,No. Jaques, Kowalko, Seigfried, D.

Short,24 K.after line 7 and before line 8 by inserting the following and redesignating accordingly:

Williams;“(2) “Contract price” means the lowest price a pharmacy is paid for the acquisition of a prescription drug based on a contract that a pharmacy has with a carrier or pharmacy benefits manager.

Sens.“Contract price” includes a dispensing fee set by a contract between a pharmacy and a carrier or pharmacy benefits manager.

Cloutier,(3) Hansen,“Pharmacy” Pettyjohn,means Sokola,as Townsend,defined Wilsonin HOUSE§ OF2502 REPRESENTATIVESof 150thTitle GENERAL24.”. ASSEMBLY HOUSE BILL NO.

24FURTHER AN ACT TO AMEND TITLEHouse 18Bill OFNo. THE DELAWARE CODE RELATING TO COPAYMENT OR COINSURANCE FOR PRESCRIPTION DRUGS.

BE24 ITby ENACTEDdeleting BYlines THE9 GENERALthrough ASSEMBLY11 OFin THEtheir STATEentirety. OF DELAWARE:

SectionFURTHER 1.AMEND House Bill No.

Amend24 Chapteron 33,line Title15 18by ofdeleting the“retail Delawareprice Codeof bythe makingprescription deletionsdrug.” asafter shown“exceeds bythe” strike through and insertionsinserting asin shownlieu bythereof underlinethe asfollowing: follows:

§“lesser 3350A.of one of the following:

Copayment(1) The applicable copayment or coinsurance that would apply for the prescription drugsdrug limited.in the absence of this section.

(a)(2) Definitions.The amount an individual would pay for the prescription drug if the individual were paying the usual and customary price.

(1)(3) "Carrier"The meanscontract anyprice entityfor thatthe providesprescription healthdrug.”. insurance in this State.

"Carrier"FURTHER includesAMEND anHouse insuranceBill company,No. health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.

(2)24 "Pharmacyafter benefitline manager"22 meansand asbefore definedline under23 §by 3302Ainserting ofthe thisfollowing title.and redesignating accordingly:

(3)“(2) “Retail“Contract price” means the amountlowest anprice individuala wouldpharmacy payis paid for the prescriptionacquisition drugof ifa the individual purchased the prescription drug withoutbased usingon a healthcontract insurancethat plan, a healthpharmacy benefithas plan,with ora anycarrier otheror sourcepharmacy of prescription drug benefits ormanager. discounts.

(b)“Contract Application.price” includes a dispensing fee set by a contract between a pharmacy and a carrier or pharmacy benefits manager.

This(3) section“Pharmacy” appliesmeans toas adefined carrierin that§ provides2502 coverage,of eitherTitle directly24.”. or through a pharmacy benefits manager, for prescription drugs under a health insurance policy or contract that is issued or delivered in this State.

(c)FURTHER AAMEND carrierHouse subjectBill toNo. this section may not impose a copayment or coinsurance requirement for a covered prescription drug that exceeds the retail price of the prescription drug.

Section24 2.by deleting lines 24 through 26 in their entirety.

AmendFURTHER SubchapterAMEND III,House ChapterBill 35,No. Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§24 3566A.on line 30 by deleting by deleting “retail price of the prescription drug.” after “exceeds the” and inserting in lieu thereof the following:

Copayment“lesser orof coinsuranceone forof prescriptionthe drugsfollowing: limited.

(a) Definitions.

(1) "Carrier" means any entity that provides health insurance in this State.

"Carrier" includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.

01/03/201903/14/2019 02:4810:04 PMAM (2)(1) "PharmacyThe benefitapplicable manager"copayment meansor ascoinsurance definedthat underwould §apply 3302Afor the prescription drug in the absence of this title.section.

(3)(2) “RetailThe price” means the amount an individual would pay for the prescription drug if the individual purchasedwere paying the prescriptionusual drugand withoutcustomary usingprice. a health insurance plan, a health benefit plan, or any other source of prescription drug benefits or discounts.

(b)(3) Application.The contract price for the prescription drug.”.

SYNOPSIS This sectionAmendment: applies to a carrier that provides coverage, either directly or through a pharmacy benefits manager, for prescription drugs under a health insurance policy or contract that is issued or delivered in this State.

(c)(1) AReplaces carrier“retail subjectprice” towith thislanguage sectionrequiring maythat a carrier not impose a copayment or coinsurance requirement for a covered prescription drug that exceeds the retaillesser priceof one of the prescriptionfollowing: drug.

Section(i) 3.the applicable copayment or coinsurance that would apply for the prescription drug in the absence of this section;

This(ii) Actthe appliesamount toan healthindividual insurancewould orpay healthfor benefitthe plansprescription covereddrug underif Sectionsthe 1individual orwere 2paying ofthe thisusual Actand thatcustomary areprice; issued or renewed on or after January 1, 2020.

SYNOPSISor This(iii) Actthe wouldcontract prohibitprice insurersfor and pharmacy benefit managers from engaging in the practiceprescription ofdrug. "clawbacks".

When(2) theProvides totala costdefinition of a“contract prescriptionprice” drugin toplace anof insurer or pharmacy benefits manager is less than a patient's co-pay, the insurerdefinition orof pharmacy“retail benefitsprice”. manager keeps the difference in a practice known as a "clawback".

According(3) toAdds a Marchdefinition 2018 report issued by the University of Southern“pharmacy” California's Schaeffer Center for Health Policy & Economics based on theits Center’suse analysisin ofthe 2013definition data from a large commercial insurer combined with data on national average drug reimbursements, almost 25% of filled“contract pharmacyprice”. prescriptions involved a patient co-payment that exceeded the average reimbursement paid by the insurer by more than $2.00.

The report further noted that overpayments were more likely to occur on claims for generic drugs than brand drugs and that the total overpayments in the Center’s sample amounted to $135 million.

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