Healthcare

Pharmacy benefits managers; various requirements; report. Prohibits a pharmacy benefits manager from (i) reimbursing a pharmacy in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee; (ii) basing pharmacy reimbursement for prescription drugs on patient outcomes, scores, or metrics; (iii) imposing a point-of-sale or retroactive fee on a pharmacy, pharmacist, or covered individual; (iv) receiving deductibles or copayments; (v) redirecting any prescription drug claims submitted by a pharmacy to any third-party discount card program, cash discount program, or any other non-insurance adjudication platform; (vi) using policy agreements incorporation into a pharmacy agreement, to materially change, alter, or modify the pharmacy agreement, reimbursement rates, payment terms, or other financial obligations; (vii) prohibiting a pharmacy from providing an individual certain information; (viii) charging a pharmacy a fee related to participation in a pharmacy network; (ix) requiring multiple specialty pharmacy accreditations as a prerequisite for participation in a pharmacy network that dispenses specialty drugs; or (x) deriving any revenue from a pharmacist, pharmacy, or covered individual in connection with performing pharmacy benefits management services. The bill requires a pharmacy benefits manager to calculate a covered individual's out-of-pocket cost for a covered prescription drug based on the net price of the prescription drug after taking into account all retained rebates associated with the prescription drug. The bill adds certain information to be included in a report that pharmacy benefit managers are currently required to submit and requires such report to be filed quarterly rather than annually. The bill also requires the Commissioner of Insurance to annually prepare and submit a report to the Governor and the General Assembly based on the information submitted by pharmacy benefits managers. Additionally, the bill prohibits a carrier or its pharmacy benefits manager from imposing any payment or condition relating to the purchase of pharmaceutical benefits from any pharmacy that is more costly or more restrictive than that which would be imposed upon such person if the same pharmaceutical services were purchased from a mail order pharmacy provider.

Unregulated pregnancy clinics; unauthorized practice of medicine; unprofessional conduct of medical providers; civil penalty. Requires unregulated pregnancy clinics, as defined by the bill, to have a qualified medical provider who supervises and takes responsibility for the provision of all medical care at such facility. The bill provides that any such clinic is required to provide to a client, upon request, the name and contact information for the qualified medical provider who supervises medical care to such client. A clinic shall notify the Board of Health, in accordance with rules promulgated by the Board, of the name and contact information for its qualified medical providers. Any person who violates the provisions of the bill is subject to a civil penalty of up to $3,000 for a first violation and up to $10,000 for a second or subsequent violation. The bill provides that individuals licensed by the Board of Medicine or the Board of Nursing are subject to disciplinary action for making or knowing of certain willful representations of the care provided at such unregulated pregnancy clinics if such representations are not true.

Board of Health; Stillbirth Support Grant Program established. Establishes the Stillbirth Support Grant Program to provide grants to individuals who deliver a stillborn child, as defined in the bill, to assist with out-of-pocket expenses associated with such delivery. The bill authorizes the Board of Health to administer the Program and establish procedures and issue guidelines for administration of the Program as it deems appropriate. An application for such grant must be submitted within one year of delivery of a stillborn child.