Bill Amendment: MS HB1665 | 2026 | Regular Session
Bill Title: Pharmacy Benefit Prompt Pay Act and State Health Insurance Plan; revise.
Status: 2026-03-26 - Died On Calendar [HB1665 Detail]
Download: Mississippi-2026-HB1665-House_Amendment_No_2_Cmte_Sub_.html
Lost
AMENDMENT NO 2 PROPOSED TO
Cmte Sub for House Bill No. 1665
BY: Representative Hobgood-Wilkes
Amend by striking all after the enacting clause and inserting in lieu thereof the following:
SECTION 1. Section 73-21-151, Mississippi Code of 1972, is amended as follows:
73-21-151.
Sections 73-21-151 through * * * 73-21-167 shall be
known as the "Pharmacy Benefit Prompt Pay Act."
SECTION 2. Section 73-21-153, Mississippi Code of 1972, is amended as follows:
73-21-153.
For purposes of Sections 73-21-151 through * * * 73-21-167, the
following words and phrases shall have the meanings ascribed herein unless the
context clearly indicates otherwise:
(a) "Board" means the State Board of Pharmacy. (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. The term "clean claim" includes resubmitted claims with previously identified deficiencies corrected.
(c) "Commissioner" means the Mississippi Commissioner of Insurance.
( * * *d) "Day" means a calendar
day, unless otherwise defined or limited.
(e) "Drug" has the same definition as provided in Section 73-21-73.
( * * *f) "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.
( * * *g) "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.
( * * *h) "Enrollee" means an
individual who has been enrolled in a pharmacy benefit management plan or
health insurance plan.
( * * *i) "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.
(j) "Network pharmacy" means a pharmacy licensed by the board which provides pharmacy services to Mississippi consumers and has a contract with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate.
(k) "Payment remittance advice" means the claim detail that the pharmacy receives when successfully processing an electronic or paper claim. The claim detail must contain, but is not limited to:
(i) The amount that the pharmacy benefit manager or PSAO will reimburse for product ingredient; and
(ii) The amount that the pharmacy benefit manager or PSAO will reimburse for product dispensing fee; and
(iii) The amount that the pharmacy benefit manager or health insurance plan dictates the patient must pay.
(l) "Pharmacist" has the same definition as provided in Section 73-21-73.
(m) "Pharmacy" has the same definition as provided in Section 73-21-73.
(n) "Pharmacy acquisition cost" means the amount that a pharmaceutical wholesaler charges for a pharmaceutical product as listed on the pharmacy's billing invoice.
( * * *o) "Pharmacy benefit
manager" * * * means an
entity that provides pharmacy benefit management services. The term
"pharmacy benefit manager" shall not include:
(i)
An insurance company unless the insurance company is providing services as a
pharmacy benefit manager * * * as defined in Section 73‑21‑179, in which case
the insurance company shall be subject to * * *
this act only for those pharmacy benefit manager services * * *; or
(ii) The Mississippi Division of Medicaid or its contractors when performing pharmacy benefit manager services for the Division of Medicaid.
( * * *p) "Pharmacy
benefit manager affiliate" means * * * an entity that,
directly or indirectly, * * *through one or more intermediaries, owns or controls, is owned
or controlled by, or is under common ownership or control with a pharmacy
benefit manager.
( * * *q) "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.
(r) "Pharmacy benefit management services" includes, but is not limited to, the following services, which may be provided either directly or through outsourcing or contracts:
(i) Adjudicate drug claims or any portion of the transaction;
(ii) Contract with retail and mail pharmacy networks;
(iii) Establish payment levels for pharmacies;
(iv) Develop formularies or drug lists of covered therapies;
(v) Provide benefit design consultation;
(vi) Manage cost and utilization trends;
(vii) Contract for manufacturer rebates;
(viii) Provide fee-based clinical services to improve member care;
(ix) Third-party administration; and
(x) Sponsoring or providing cash discount cards, as defined in Section 83-9-6.1, and electronic discount cards.
(s) "Pharmacist services" means products, goods and services, or any combination of products, goods and services, provided as part of the practice of pharmacy.
(t) "Pharmacy services administrative organization" or "PSAO" means an entity that contracts with a pharmacy or pharmacist to assist with third-party payer interactions and which 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. A covered entity, as defined in 42 USC Section 256b, including its pharmacy or the transactions related to the 340B drug discount program of a pharmacy contracted with the participating covered entity to dispense drugs purchased through the 340B drug discount program, is not considered to be a pharmacy services administrative organization.
(u) "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 or services, or both.
(v) "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.
(w) "Rebate" means any and all payments and price concessions that accrue to a pharmacy benefit manager or its plan 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, price concessions or penalties associated, directly or indirectly, in any way with claims administered on behalf of a plan sponsor.
(x) "Spread pricing" means an 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 a pharmacy, pharmacist or other provider on behalf of the health benefit plan.
* * *
( * * *y) "Uniform claim form"
means a form prescribed by rule by the * * * board; however,
for purposes of * * * this act,
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. The board may
modify the terminology of the rule and form when necessary to comply with the
provisions of * * * this act.
(z) "Wholesale acquisition cost" means the wholesale acquisition cost of the drug as defined in 42 USC Section 1395w-3a(c)(6)(B).
* * *
SECTION 3. Section 73-21-155, Mississippi Code of 1972, is amended as follows:
73-21-155.
(1) Reimbursement * * * to a pharmacist or pharmacy by a pharmacy benefit
manager or PSAO for the dispensing of a prescription drug * * * and other products and supplies * * *
shall be a net amount not less than the greater of:
(a) The total reimbursement paid to its pharmacy benefit manager affiliate; or
(b) The total reimbursement paid by the Mississippi Division of Medicaid in its pharmacy reimbursement methodology.
(2)
* * *
(a) All benefits
payable * * *
from a pharmacy benefit * * * manager or PSAO shall be
paid within seven (7) days after receipt of * * * a clean electronic
claim where * * * the claim was electronically adjudicated,
and shall be paid within thirty-five (35) days after receipt of due written
proof of a clean claim where claims are submitted in paper format. Benefits * * * 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 * * * plan. * * *
* * *
( * * *b) * * * If an electronic claim is
denied, the pharmacy benefit manager shall * * * notify the pharmacist or pharmacy * * *
within seven (7) days 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. * * * If a written claim is denied, the
pharmacy benefit manager shall notify the pharmacy or pharmacies no later
than thirty-five (35) days * * * of receipt of the claim * * *. The pharmacy benefit manager shall * * * notify 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. Any claim or portion thereof resubmitted with
the supporting documentation and information requested by the pharmacy benefit
manager shall be paid within twenty (20) days after receipt.
( * * *3) If the board finds that any pharmacy
benefit manager, PSAO, 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 * * * Section 73-21-153,
received from all pharmacies in a calendar quarter, * * * the pharmacy benefit manager, PSAO, agent
or other party shall be subject to an administrative penalty of not
more than Twenty-five Thousand Dollars ($25,000.00) to be assessed by the State
Board of Pharmacy.
(a)
Examinations to determine compliance with this * * * section may be conducted by
the board. The board may contract with qualified impartial outside sources to
assist in examinations to determine compliance. * * *
(b)
Nothing in the provisions of this section shall require a pharmacy benefit
manager to pay claims that are not covered under the terms of a contract * * *, plan, policy of accident and
sickness insurance or prepaid coverage.
* * *
( * * *c) Any pharmacy benefit manager * * * may enter into an express
written agreement * * *
with a pharmacy or PSAO on behalf of a pharmacy that contains timely
claim payment provisions which differ from, but are at least as stringent as,
the provisions set forth under subsection ( * * *2) 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 or PSAO to the pharmacy. 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) * * *
of this section shall apply.
( * * *d) The State Board of Pharmacy may
adopt rules and regulations necessary to ensure compliance with this
subsection.
( * * *4) If a clean claim is not paid or
is denied without providing to the pharmacy a valid and proper reason as to why
the claim is not clean by the end of the applicable time period prescribed in
this section, the pharmacy benefit manager must pay the pharmacy (when the
claim is owed to the pharmacy) or the patient (when the claim is owed to a
patient) interest on accrued benefits at the rate of one and one-half percent
(1-1/2%) per month accruing from the day after payment was due on the amount of
the benefits that remain unpaid until the claim is finally settled or
adjudicated. Whenever interest due pursuant to this subsection is less than
One Dollar ($1.00), such amount shall be credited to the account of the person
or entity to whom such amount is owed.
(5)
(a) * * * A network
pharmacy or pharmacist may decline to provide a brand name drug, * * * generic drug, biosimilar drug
or service, if the network pharmacy or pharmacist is paid less than that
network pharmacy's acquisition cost for the * * * prescription. If the network
pharmacy or pharmacist declines to provide such drug or service, the pharmacy
or pharmacist shall provide the customer with adequate information as to where
the prescription for the drug or service may be filled. A pharmacy benefit
manager may not require a pharmacy or pharmacist to submit a claim for payment
through a plan of the patient when the patient requests to pay for the
prescription drug with cash or an alternative payment method.
(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 and also in cases where a network pharmacy or
pharmacist declines to provide a drug or service under paragraph (a) of this
subsection. * * *
(6) A pharmacy benefit manager or PSAO 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.
(7) A pharmacy benefit manager or PSAO may not impose a fee or otherwise adjust or lower the reimbursement of a claim at the time the claim is adjudicated, or after the claim is adjudicated, which reduces the amount of the reimbursement for the claim.
SECTION 4. Section 73-21-156, Mississippi Code of 1972, is amended as follows:
73-21-156.
(1) * * *
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.
A pharmacy
benefit manager shall:
(a)
Provide a reasonable administrative
appeal procedure to allow pharmacies to challenge * * *
reimbursements made * * * for a specific drug or drugs as:
(i)
Not meeting the requirements of this
section; * * *
(ii)
Being below the pharmacy acquisition
cost * * *;
or
(iii) Being below the reimbursement rate required under subsection (1) of Section 173-51-155.
(b) The reasonable administrative appeal procedure shall include the following:
(i) A * * * telephone number * * * and email address * * * on the main page of the website of the pharmacy benefit
manager which provides direct access to the claim appeals department;
(ii) The pharmacy benefit manager shall provide a detailed written response within seven (7) days of receipt of an email or telephone call from a pharmacist or pharmacy regarding an issue with an administrative appeal;
(iii) The website of the pharmacy benefit manager must include easily accessible administrative appeal instructions and list any other required information to be submitted by pharmacies for the purpose of submitting administrative appeals;
(iv)
The ability to submit * * * a single administrative appeal or
a claim appeal report for multiple claims directly to the pharmacy benefit
manager * * * or through a * * * PSAO;
and
( * * *v)
A period of no less than thirty (30) * * * days to file an administrative appeal.
(c) The pharmacy benefit manager shall respond to the
challenge under * * * this subsection * * * within thirty (30) * * * days after receipt of the challenge.
(d)
If a challenge is made under * * * this subsection * * *, the pharmacy benefit manager shall,
within thirty (30) * * *
days after receipt of the challenge, either:
(i) * * * Uphold the appeal * * * and:
1. * * * Adjust the
reimbursement or reimbursements paid to the pharmacist or pharmacy to the
greater of either the pharmacy acquisition cost or the amount required under
subsection (1) of Section 73-21-155; and
2. Permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question; and
* * *
* * *3. Make
the * * * adjustment for that National Drug Code
effective for * * * the pharmacy * * * that filed the claim for a time period of no less than
ninety (90) days from the date the claim appeal was upheld; or
(ii) * * * Deny the appeal * * * and provide the reason for
the denial in writing to the challenging pharmacy or pharmacist * * *
.
(e) The board may adopt rules and regulations necessary to ensure compliance with this subsection.
(2) A pharmacy benefit manager may not deny an appeal submitted pursuant to this section based upon an existing contracted rate with the pharmacy.
(3) A pharmacy or pharmacist that belongs to a PSAO must be provided a true and correct copy of a contract and contract amendment that the PSAO enters into with a pharmacy benefit manager or third-party payer on the pharmacy's or pharmacist's behalf.
( * * *4)
* * * A pharmacy benefit manager or PSAO
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 * * * drug, and the
amount reimbursed may not be less than the amount prescribed pursuant to
subsection (1) of Section 73-21-155.
* * * The
reimbursement amount for a drug shall be calculated on a per unit
basis based on the same brand and generic product identifier or brand and
generic code number.
(5) The pharmacy benefit manager or PSAO may not require a pharmacy to collect additional monies following a successful below-cost reimbursement appeal from a person or entity other than the pharmacy benefit manager who adjudicated the drug claim, including the patient or plan sponsor.
SECTION 5. Section 73-21-157, Mississippi Code of 1972, is amended as follows:
73-21-157. (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. To obtain a license, the applicant shall submit an application to the board on a form to be prescribed by the board. The license must be renewed annually.
(2)
When applying for a license or renewal of a license, each pharmacy
benefit manager * * * shall file * * * with the board * * *
:
(a) (i) 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; of
(ii) If the pharmacy benefit manager has not been audited in the last twenty-four (24) months, a financial statement of the organization, including its balance sheet and income statement for the preceding year which is verified by at least two (2) principal officers; and
(b)
Any other information relating to the operations of the pharmacy benefit
manager or PSAO required by the board * * *.
( * * *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 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.
SECTION 6. The following shall be codified as Section 73-21-158, Mississippi Code of 1972:
73-21-158. (1) A pharmacy benefit manager is prohibited from engaging in spread pricing. Separately identified administrative fees or costs are exempt from this requirement, if mutually agreed upon in writing by the payor and pharmacy benefit manager.
(2) A pharmacy benefit manager or third-party payer may not charge or cause a patient to pay an amount that exceeds the total amount retained by the pharmacy.
(3) A pharmacy benefit manager shall pass on to the plan sponsor one hundred percent (100%) of all rebates and other payments that the pharmacy benefit manager received from pharmaceutical manufacturers or rebate aggregators in connection with claims if administered on behalf of the plan sponsor.
(4) A pharmacy benefit manager or PSAO may not charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including, without limitation, a fee for:
(a) The submission or processing of a claim;
(b) The adjudication of a claim;
(c) Enrollment or participation in a pharmacy network; or
(d) The development or management of claims processing services or claims payment services related to participation in a pharmacy network.
(5) A pharmacy benefit manager or PSAO shall not charge a pharmacist or pharmacy a fee related to participation in a pharmacy network, including, but not limited to, the following:
(a) An application fee;
(b) An enrollment or participation fee;
(c) A credentialing or re-credentialing fee;
(d) A change of ownership fee; or
(e) A fee for the development or management of claims processing services or claims payment services.
SECTION 7. Section 73-21-159, Mississippi Code of 1972, is brought forward as follows:
73-21-159. (1) In lieu of or in addition to making its own financial examination of a pharmacy benefit manager, the board may accept the report of a financial examination of other persons responsible for the pharmacy benefit manager under the laws of another state certified by the applicable official of such other state.
(2) The board shall coordinate financial examinations of a pharmacy benefit manager that provides pharmacy management benefit plans in this state to ensure an appropriate level of regulatory oversight and to avoid any undue duplication of effort or regulation. The pharmacy benefit manager being examined shall pay the cost of the examination. The cost of the examination shall be deposited in a special fund that shall provide all expenses for the licensing, supervision and examination of all pharmacy benefit managers subject to regulation under Sections 73-21-71 through 73-21-129 and Sections 73-21-151 through 73-21-163.
(3) The board may provide a copy of the financial examination to the person or entity who provides or operates the health insurance plan or to a pharmacist or pharmacy.
(4) The board is authorized to hire independent financial consultants to conduct financial examinations of a pharmacy benefit manager and to expend funds collected under this section to pay the costs of such examinations.
SECTION 8. 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 plan designs that require a patient to utilize an affiliate pharmacy or pharmacies, or that increase costs to a patient, including, but not limited to, requiring a patient to pay the full cost for a prescription drug when the 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, but * * * 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 pharmacy benefit
manager affiliate includes information regarding eligible nonaffiliate
pharmacies in those communications and the information provided is accurate.
(d) Creating a network or engaging in a practice, including accreditation or credentialing standards, day supply requirements or delivery methods requirements, which excludes an in-network pharmacy or restricts an in-network pharmacy from filling a prescription for a prescription drug; or
(e) Directly or indirectly engaging in a 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 that drug to nonaffiliate pharmacies.
(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 compliance; pharmacy care; public health
activities otherwise authorized by law; or utilization review by a health care
provider; * * *
(c)
Presenting a claim for payment to any individual, third-party payor, affiliate,
or other entity for a prescription drug or 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 affiliate violates 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, pharmacy benefit
manager or pharmacy benefit manager affiliate 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.
(6) This section does not apply to facilities licensed to fill prescriptions solely for employees of a plan sponsor or employer.
SECTION 9. The following shall be codified as Section 73-21-162, Mississippi Code of 1972:
73-21-162. (1) (a) Retaliation is prohibited.
(b) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO may not retaliate against a pharmacist or pharmacy based on the pharmacist's or pharmacy's exercise of a 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 money owed by the pharmacy benefit manager to the pharmacist or pharmacy.
(c) 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
(ii) Provides reasonable notice and a reasonable opportunity to respond 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 may not penalize or retaliate against a pharmacist, pharmacy or pharmacy employee for exercising rights under this chapter, initiating a judicial or regulatory action 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 a governmental agency, legislative member or body, or a judicial authority.
SECTION 10. 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 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 * * *, 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 and reduce its decision to writing. Each instance that
a pharmacy benefit manager or PSAO fails to comply with the written order of
the board is a separate violation of this act. 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 also may issue subpoenas to any individual, pharmacy, pharmacy benefit manager, PSAO or 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, including cost of process service, court reports, expert witnesses and investigators, if the board imposes a monetary penalty under subsection (2) of this section.
(5)
* * * Monetary * * * penalties and costs 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 ( * * *5) shall be deposited into the special
fund of the board.
( * * *6) 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.
(7) (a) The board may conduct audits to ensure compliance with the provisions of this act. In conducting audits, the board may request production of documents pertaining to compliance with the provisions of this act, and documents so requested must 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 is found to be in compliance with all of the requirements of this act, then the board must pay the costs of the audit. However, the pharmacy benefit manager or PSAO being audited shall pay all costs of the audit if the audit reveals noncompliance with this act. The cost of the audit examination must be deposited into the special fund and used by the board, upon appropriation by the Legislature, to support the operations of the board relating to the regulation of pharmacy benefit managers.
(c) The board may hire independent consultants to conduct audits of a pharmacy benefit manager or PSAO and expend funds collected under this section to pay the cost of performing audit services.
( * * *8) 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 be reflected in the minutes of the board and shall not be imposed
unless it appears as having been adopted by the board.
SECTION 11. The following shall be codified as Section 73-21-165, Mississippi Code of 1972:
73-21-165. (1) A pharmacy benefit manager shall report to the board annually, or more often as the board deems necessary, for each plan sponsor the following information:
(a) The aggregate amount of rebates and other payments that the pharmacy benefit manager received from pharmaceutical manufacturers or rebate aggregators in connection with claims if administered on behalf of the plan sponsor;
(b) The aggregate amount of rebates distributed to each plan sponsor contracted with the pharmacy benefit manager;
(c) The aggregate amount of rebates passed on to the enrollees of each plan sponsor at the point of sale that reduced the enrollees' applicable deductible, copayment, coinsurance or other cost-sharing amount;
(d) The individual and aggregate amount paid by the plan sponsor to the pharmacy benefit manager for pharmacist services itemized by pharmacy, by product, and by good and services;
(e) The individual and aggregate amount a pharmacy benefit manager paid for pharmacist services itemized by pharmacy, product, and by goods and services; and
(f) If at any time during the reporting period the pharmacy benefit manager moved or reassigned a prescription drug to a formulary tier that has a higher cost, higher copayment, higher coinsurance, higher deductible to a consumer, or lower reimbursement to a pharmacy, an explanation of the reason why the drug was moved or reassigned, including whether the move or reassignment was determined or requested by a pharmaceutical manufacturer or other entity.
(2) (a) A pharmacy benefit manager shall report annually, in the aggregate, to the board and to a plan sponsor the difference between the amount the pharmacy benefit manager reimbursed a pharmacy and the amount the pharmacy benefit manager charged a plan sponsor.
(b) A pharmacy benefit manager shall report to each plan sponsor the aggregate amount of all rebates and other payments that the pharmacy benefit manager received from pharmaceutical manufacturers or rebate aggregators in connection with claims if administered on behalf of the plan sponsor.
(3) A pharmacy benefit manager that owns, controls or is affiliated with a pharmacy also shall report annually to the board any difference in reimbursement rates or practices, direct and indirect renumeration fees or other price concessions, and any reduction in reimbursements between a pharmacy that is owned, controlled or affiliated with the pharmacy benefit manager and another pharmacy.
SECTION 12. The following shall be codified as Section 73-21-167, Mississippi Code of 1972:
73-21-167. (1) There is created the Mississippi Specialty Drug Committee that shall develop a list of prescription drugs that meet the criteria for specialty drug designation to assist with patient access, transparency and responsible cost management. The committee shall meet to review and update the list based on market trends, clinical data and stakeholder input.
(2) The committee shall be composed of the following members:
(a) A licensed pharmacist from each of the following organizations: the Mississippi Independent Pharmacies Association; the Mississippi Pharmacy Association; the Mississippi Society of Health-System Pharmacists; and the Magnolia State Pharmaceutical Society;
(b) Two (2) licensed physicians appointed by the Mississippi State Medical Association;
(c) A representative from the Mississippi Association of Health Plans;
(d) A representative from Pharmaceutical Care Management Association;
(e) A representative from Mississippi Business Alliance;
(f) The Executive Director of the State Board of Pharmacy, or his or her designee, to serve as nonvoting temporary chair for the initial organizational meeting of the committee;
(g) A representative from the Office of Insurance of the Department of Finance and Administration;
(h) The chair or his or her designee of the Senate Drug Policy Committee, to serve as a nonvoting member; and
(i) The chair or his or her designee of the House Drug Policy Committee, to serve as a nonvoting member.
(3) (a) Appointments to the committee must be made and provided to the Executive Director of the State Board of Pharmacy before August 1, 2026. Within fifteen (15) days thereafter, on a day to be designated by the executive director of the board, the committee shall meet and organize by selecting from its membership a chair and a vice chair. The vice chair shall serve as secretary and be responsible for keeping all records of the committee. A majority of the members of the committee constitutes a quorum. In the selection of its officers and the adoption of the specialty drug list, rules, resolutions and reports, an affirmative vote of the majority of the voting committee members present is required. All members must be notified in writing of all meetings, and those notices must be mailed at least fifteen (15) days before the date on which a meeting is to be held.
(b) The committee shall meet at least once quarterly and shall create the initial list of specialty drugs no later than December 1, 2026. The initial and updated lists of specialty drugs must be posted on the official website of the state agencies and boards serving on the committee.
(4) The State Board of Pharmacy shall provide the office space, staff and other support necessary for the committee to perform its duties.
(5) Pharmacy benefit managers licensed with the board shall adhere to the established list of specialty drugs when contracting with a pharmacy and establishing payment levels and adjudicating drug claims or any portion of the transaction. Noncompliance with this subsection shall be deemed a violation of this act.
SECTION 13. The following shall be codified as Section 73-21-211, Mississippi Code of 1972:
73-21-211. Sections 73-21-211 through 73-21-217 shall be known as the "Pharmacy Fair Competition Act."
SECTION 14. The following shall be codified as Section 73-21-213, Mississippi Code of 1972:
73-21-213. The Legislature finds and declares that the distribution and retail sales of pharmaceutical drugs in the State of Mississippi vitally affects the general economy of the state and the public interest and the public welfare. The Legislature further finds and declares that it is necessary, in the exercise of its police power, to regulate, register and/or license drug manufacturers, wholesale distributors, pharmacy service administration organizations and retail pharmacies doing business in the State of Mississippi in order to:
(a) Prevent frauds, unfair practices, discrimination, impositions and other abuses upon the citizens of the State of Mississippi;
(b) Avoid undue control of the retail pharmacy by drug manufacturing and distributing organizations, pharmacy service administration organizations or pharmacy benefit managers;
(c) Foster and keep alive vigorous and healthy competition;
(d) Prevent the creation or perpetuation of monopolies;
(e) Prevent the practice of requiring unnecessary requirements on retail pharmacies that add to the costs and timely administration of healthcare to Mississippi citizens;
(f) Prevent false and misleading advertising; and
(g) Promote the public safety and welfare.
SECTION 15. The following shall be codified as Section 73-15-215, Mississippi Code of 1972:
73-21-215. (1) As used in Sections 73-15-211 through 73-15-217, the following words and phrases have the meanings provided in this subsection unless the context clearly requires otherwise:
(a) "Board" means the State Board of Pharmacy.
(b) "Permit" means a permit issued under Section 73-21-105 or Section 73-21-106.
(c) "Pharmacy benefit manager" has the same definition as provided in Section 73-21-153.
(d) "Plan sponsor" has the same definition as provided in Section 73-21-153.
(2) (a) A pharmacy benefit manager may not acquire direct or indirect interest in, or otherwise hold, directly or indirectly, a pharmacy permit for the retail sale of drugs or medicines in this state.
(b) On and after July 1, 2026, the State Board of Pharmacy shall either revoke or not renew a pharmacy permit of an entity that violates this section.
(3) (a) The board may issue a limited use permit upon a determination that certain rare, orphan or limited distribution drugs are otherwise unavailable in the market to a patient or a pharmacy which would otherwise be prohibited under this section.
(b) The board may assess the need for rare, orphan or limited distribution drugs for a limited use permit for certain rare, orphan or limited distribution drugs under paragraph (a) of this subsection before revocation or renewal of an existing retail permit for a pharmacy. If the assessment made by the board under this paragraph determines that a rare, orphan or limited distribution drug is otherwise unavailable in the market to a patient or pharmacy which would otherwise be prohibited in this section, the board shall convert the retail permit for the prohibited pharmacy to a limited use permit for that pharmacy for a period of no less than ninety (90) days.
(c) A limited use permit may not be issued by the board if a determination is made that the unavailability of the rare, orphan or limited distribution drug has been created by the pharmacy benefit manager or plan sponsor.
(4) The process for requesting a limited use permit is as follows:
(a) A request by a permitted pharmacy for a limited use permit for a rare, orphan or limited distribution drug unavailable in the market must be made in writing to the board.
(b) The written request must provide the name and description of the drug, a detailed description of the patient need for the drug, and an explanation as to why the rare, orphan or limited distribution drug is unavailable in the market.
(c) The executive director for the board shall review the written request and make a determination on whether to issue the limited use permit within twenty (20) days from the date of the written request.
(d) If the requestor is aggrieved by the decision of the executive director, a petition may be made to the board, in writing, and an administrative hearing on the matter must be held before the board within twenty (20) days of receipt of the petition.
(e) Within thirty (30) days after conclusion of the hearing, the board shall reduce its decision to writing and forward an attested true copy thereof to the last-known business address of the pharmacy permit via United States first-class, certified mail, postage prepaid, and by email to the address provided to the board in its licensing system.
(f) If the requestor asserts in the written request that there is a need for an emergency determination due to patient need, a permitted pharmacy may dispense a one-time emergency dispensing of the rare, orphan or limited distribution drug for up to twenty (20) days from the date of the written request pending a decision by the executive director of the board. The written request must include information describing that there is need for an emergency determination due to patient need and provide a detailed reason for the emergency.
(5) The board may extend the use of a retail permit or issue a renewal of a retail permit for a pharmacy that offers same-day patient access for pharmacist services, a prescription for a controlled substance, mental health services, or other critical patient healthcare services for a period of time as determined by order of the board if there is a pending sale of the pharmacy to an eligible buyer.
(6) This section does not apply to a pharmacy employer or a pharmacy that exclusively services the employees and dependents of the pharmacy employer while utilizing the affiliated pharmacy benefit manager in this state.
SECTION 16. The following shall be codified as Section 73-21-217, Mississippi Code of 1972:
73-21-217. (1) The board shall conduct an initial assessment of each active retail pharmacy permit issued as of July 1, 2026, and shall send written notice at least ninety (90) days before January 1, 2027, to each pharmacy permit holder that the board reasonably believes will be found to be in violation of this act. As used in this subsection, "written notice" means actual notice to the pharmacy permit holder via mail or email, including an email through its licensing system.
(2) The written notice required under subsection (1) of this section must include a list of each pharmacy benefit manager that holds a direct or indirect interest in, or otherwise holds, directly or indirectly, a permit under Section 73-21-105 or Section 73-21-106 for the retail sale of drugs or medicines in this state held by the pharmacy permit holder.
(3) (a) A pharmacy permit holder with written notice from the board under subsection (1) of this section must provide written notice at least sixty (60) days before January 1, 2027, to each patient and each patient's prescribing healthcare provider that has used the pharmacy within the previous twelve (12) months that the pharmacy can no longer dispense retail drugs to the patient on or after January 1, 2027. As used in this subsection, "written notice" means actual notice to the patient via mail, email, or through the pharmacy's patient portal.
(b) A pharmacy that is determined by the board to be in violation of this section after the date set forth in subsection (1) is not exempt from this act. Within sixty (60) days of a written notice from the board, those pharmacies must provide written notice to each patient and each patient's prescribing healthcare provider that has used the pharmacy within the previous twelve (12) months that the pharmacy can no longer dispense retail drugs to the patient after thirty (30) days from the date of the pharmacy's notice.
(4) Each licensed pharmacy benefit manager licensed as of July 1, 2026, shall send a written list to the board, no later than September 1, 2026, of any retail pharmacy that the pharmacy benefit manager holds a direct or indirect interest in, or otherwise holds, directly or indirectly, and is permitted by the board.
(5) Each permitted retail pharmacy permitted as of July 1, 2026, shall send a written list to the board, no later than September 1, 2026, of any pharmacy benefit manager that holds a direct or indirect interest in, or otherwise holds, directly or indirectly, the permitted retail pharmacy.
SECTION 17. Section 25-15-301, Mississippi Code of 1972, is amended as follows:
25-15-301. (1) The board may contract the administration and service of the self-insured program to a third party. Whenever the board chooses to contract with an administrator for the insurance plan established by Section 25-15-3 et seq. or components thereof, it shall comply with the procedures set forth in this section:
(a) If the board determines that it should contract out the administration of the plan to an administrator, it shall cause to be prepared a request for proposals. This request for proposals shall be prepared for distribution to any interested party. Notice of the board's intention to seek proposals shall be published in a newspaper of general circulation at least one (1) time per week for three (3) weeks before closing the period for interested parties to respond. Additional forms of notice may also be used. The newspaper notice shall inform the interested parties of the service to be contracted, existence of a request for proposals, how it can be obtained, when a proposal must be submitted, and to whom the proposal must be submitted. All requests for proposals shall describe clearly what service is to be contracted, and shall fully explain the criteria upon which an evaluation of proposals shall be based. The criteria to be used for evaluations shall, at minimum, include:
(i)
The administrator's proven ability to handle * * * group accident and health insurance plans
comparable to the plan;
(ii) The efficiency of the claims-paying procedures;
(iii)
* * *
The total charges for administering the plan.
(b) All proposals submitted by interested parties shall be evaluated by an internal review committee which shall apply the same criteria to all proposals when conducting an evaluation. The committee shall consist of at least three (3) members of the board. When the proposal under evaluation is for pharmacy benefits or the management thereof, the Executive Director of the State Board of Pharmacy, or his or her designee, shall be one (1) of the members of the evaluation committee. The results and recommendations of the evaluation shall be presented to the board for review. All evaluations presented to the board shall be retained by the board for at least three (3) years. The board may accept or reject any recommendation of the review committee, or it may conduct further inquiry into the proposals. Any further inquiry shall be clearly documented and all methods and recommendations shall be retained by the board and shall spread upon its minutes its choice of administrator and its reasons for making the choice.
(c) (i) The board shall be responsible for preparing a contract that shall be in accordance with all provisions of this section and all other provisions of law. The contract shall also include a requirement that the contractor shall consent to an evaluation of his performance. Such evaluation shall occur after the first six (6) months of the contract, and the contractor's performance shall be reviewed at times the board determines to be necessary. The contract shall clearly describe the standards upon which the contractor shall be evaluated. Evaluations shall include, but not be limited to, efficiency in claims processing, including the processing pending claims.
(ii) The PEER Committee, at the request of the House or Senate Appropriations Committee or the House or Senate Insurance Committee and with funds specifically appropriated by the Legislature for such purpose, shall contract with an accounting firm or with other professionals to conduct a compliance audit of any administrator responsible for administering the insurance plan established by Section 25-15-3 et seq. or components thereof. Such audit shall review the administrator's compliance with the performance standards required for inclusion in the administrator's contract. Such audit shall be delivered to the Legislature no later than January 1.
(iii) An audit for pharmacy benefits or the management thereof also may be conducted by the State Board of Pharmacy under the provisions of Chapter 21, Title 73, Mississippi Code 1972. Any audit conducted by the State Board of Pharmacy must be provided to the board and the PEER Committee within fifteen (15) days of final adoption of the results by the State Board of Pharmacy.
(2) Contracts for the administration of the insurance plan established in Section 25-15-3 et seq. or components thereof shall commence at the beginning of the calendar year and shall end on the last day of a calendar year. This shall not apply to contracts provided for in subsection (3) of this section.
(3) If the board determines that it is necessary to not renew the contract of an administrator, or finds it necessary to terminate a contract with or without cause as provided for in the contract of the administrator, the board is authorized to select an administrator without complying with the bid requirements in subsections (1) and (2) of this section. Such contracts shall be for the balance of the calendar year in which the nonrenewal or termination occurred, and may be for an additional calendar year if the board determines that the best interests of the plan members are served by such. Any contract negotiated on an interim basis shall include a detailed transition plan which shall ensure the orderly transfer of responsibilities between administrators and shall include, but not be limited to, provisions regarding the transfer of records, files and tapes.
(4) Except for contracts executed under the authority of subsection (3) of this section, the board shall select administrators at least six (6) months before the expiration of the current administrator's contract. The period between the selection of the new administrator and the effective date of the new contract shall be known as the transition period. Whenever the newly selected administrator is an entity different from the entity performing the administrator's function, it shall be the duty of the board to prepare a detailed transition plan which shall insure the orderly transfer of responsibilities between administrators. This plan shall be effective during the transition period, and shall include, but not be limited to, provisions regarding the transfer of records, files and tapes. Further, the plan shall detail the steps necessary to transfer records and responsibilities and set deadlines for when such steps should be completed. The board shall include in all requests for proposals, contracts with administrators, and all other contracts, provisions requiring the cooperation of administrators and contractors in any future transition of responsibilities, and their cooperation with the board and other contractors with respect to ongoing coordination and delivery of health plan services. The board shall furnish the Legislature, Governor and advisory council with copies of all transition plans and keep them informed of progress on such plans.
(5) No brokerage fees shall be paid for the securing or executing of any contracts pertaining to the insurance plan established by Section 25-15-3 et seq. or components thereof, whether fully insured or self-insured.
(6) (a) Any corporation, association, company, entity or individual that contracts with the board for the administration or service of the self-insured plan shall remit one hundred percent (100%) of all savings or discounts resulting from any contract to the board or participant, or both. Any corporation, association, company, entity or individual that contracts with the board for the administration or service of the self-insured plan shall allow, upon notice by the board, the board or its designee to audit records of the corporation, association, company, entity or individual relative to the corporation, association, company, entity or individual's performance under any contract with the board. The information maintained by any corporation, association, company, entity or individual, relating to such contracts, shall be available for inspection upon request by the board and such information shall be compiled in a manner that will provide a clear audit trail.
(b) A corporation, association, company, entity or individual that contracts with the board for the administration or service of the pharmacy benefits or management thereof of the self-insured plan shall comply with the provisions of Chapter 21, Title 73, Mississippi Code 1972. If there is a conflict in the application or interpretation of these provisions, then the provision of those statutes will prevail.
SECTION 18. Section 25-15-303, Mississippi Code of 1972, is amended as follows:
25-15-303. (1) There is created the State and School Employees Health Insurance Management Board, which shall administer the State and School Employees Life and Health Insurance Plan provided for under Section 25-15-3 et seq. The State and School Employees Health Insurance Management Board, hereafter referred to as the "board," shall also be responsible for administering all procedures for selecting third-party administrators provided for in Section 25-15-301.
(2) The board shall consist of the following:
(a) The Chairman of the Workers' Compensation Commission or his or her designee;
(b) The State Personnel Director, or his or her designee;
(c) The Commissioner of Insurance, or his or her designee;
(d) The Commissioner of Higher Education, or his or her designee;
(e) The State Superintendent of Public Education, or his or her designee;
(f) The Executive Director of the Department of Finance and Administration, or his or her designee;
(g) The Executive Director of the Mississippi Community College Board, or his or her designee;
(h) The Executive Director of the Public Employees' Retirement System, or his or her designee;
(i) The Executive Director of the State Board of Pharmacy, or his or her designee;
(j) Two (2) appointees of the Governor whose terms shall be concurrent with that of the Governor, one (1) of whom shall have experience in providing actuarial advice to companies that provide health insurance to large groups and one (1) of whom shall have experience in the day-to-day management and administration of a large self-funded health insurance group;
( * * *k) The Chairman of the Senate
Insurance Committee, or his or her designee;
( * * *l) The Chairman of the House of
Representatives Insurance Committee, or his or her designee;
( * * *m) The Chairman of the Senate
Appropriations Committee, or his or her designee; and
( * * *n) The Chairman of the House of
Representatives Appropriations Committee, or his or her designee.
The legislators, or their designees, shall serve as ex officio, nonvoting members of the board.
The Executive Director of the Department of Finance and Administration shall be the chairman of the board.
(3) The board shall meet at least monthly and maintain minutes of the meetings. A quorum shall consist of a majority of the authorized voting membership of the board. The board shall have the sole authority to promulgate rules and regulations governing the operations of the insurance plans and shall be vested with all legal authority necessary and proper to perform this function including, but not limited to:
(a) Defining the scope and coverages provided by the insurance plan;
(b) Seeking proposals for services or insurance through competitive processes where required by law and selecting service providers or insurers under procedures provided for by law; and
(c) Developing and adopting strategic plans and budgets for the insurance plan.
The department shall employ a State Insurance Administrator, who shall be responsible for the day-to-day management and administration of the insurance plan. The Department of Finance and Administration shall provide to the board on a full-time basis personnel and technical support necessary and sufficient to effectively and efficiently carry out the requirements of this section.
(4) Members of the board shall not receive any compensation or per diem, but may receive travel reimbursement provided for under Section 25-3-41 except that the legislators shall receive per diem and expenses, which shall be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session; however, no per diem and expenses for attending meetings of the board shall be paid while the Legislature is in session.
SECTION 19. Section 25-15-3, Mississippi Code of 1972, is brought forward as follows:
25-15-3. For the purposes of this article, the words and phrases used herein shall have the following meanings:
(a) "Employee" means a person who works full time for the State of Mississippi and receives his compensation in a direct payment from a department, agency or institution of the state government and any person who works full time for any school district, community/junior college, public library or university-based program authorized under Section 37-23-31 for deaf, aphasic and emotionally disturbed children or any regular nonstudent bus driver. This shall include legislators, employees of the legislative branch and the judicial branch of the state and "employees" shall include full-time salaried judges and full-time district attorneys and their staff and full-time compulsory school attendance officers. For the purposes of this article, any "employee" making contributions to the State of Mississippi retirement plan shall be considered a full-time employee. For purposes of this article, "employee" shall not mean contract personnel.
(b) "Department" means the Department of Finance and Administration.
(c) "Plan" means the State and School Employees Life and Health Insurance Plan created under this article.
(d) "Fund" means the State and School Employees Insurance Fund set up under this article.
(e) "Retiree" means any employee retired under the Mississippi retirement plan.
(f) "Board" means the State and School Employees Health Insurance Management Board created under Section 25-15-303.
SECTION 20. Section 25-15-5, Mississippi Code of 1972, is brought forward as follows:
25-15-5. (1) The board shall administer the plan and is authorized to adopt and promulgate rules and regulations for its administration, subject to the terms and limitations contained in this article.
(2) The board shall develop a five-year strategic plan for the insurance plan established by Section 25-15-3 et seq. The strategic plan shall address, but not be limited to:
(a) Changing trends in the health care industry, and how they effect delivery of services to members of the plan.
(b) Alternative service delivery systems.
(c) Any foreseeable problems with the present system of delivering and administering health care benefits in Mississippi.
(d) The development of options and recommendations for changes in the plan.
(3) To carry out the requirements of subsection (2) of this section, the board may conduct formal research, including questionnaires and attitudinal surveys of members' needs and preferences with respect to service delivery.
(4) After the board has complied with all provisions of Section 25-15-9 regarding the establishment of the plan, it shall be responsible for fully disclosing to plan members the provisions of the plan. Such disclosure shall consist of the dissemination of educational material on the plan and any proposed changes thereto. The board shall provide members with complete educational materials at least thirty (30) days before the date upon which the plan's members must select a plan option for health care services. The board shall further use the resources of the Mississippi Authority for Educational Television or other state agency, university or college to provide information on proposed changes. The board may also use other state-owned media, as well as public service announcements on private media to disseminate information regarding proposed changes in the plan.
(5) The board shall develop and make available for public review at its offices a comprehensive plan document which documents all benefits for which members of the plan created by Section 25-15-3 et seq. are eligible. This document shall be typed and maintained also at the offices of any administrator contracted with in accordance with Section 25-15-301.
(6) (a) The board may enter into contracts with accountants, actuaries and other persons from the private sector whose skills are necessary to carry out the purposes of Section 25-15-3 et seq.
(b) Before the board enters into any contract for services as provided in paragraph (a) of this subsection, the board shall first determine that the services are required, and that the staff of the board and personnel of other state agencies are not sufficiently experienced to provide the services.
(c) If the service is to be rendered for a period of in excess of six (6) months, the board shall seek and obtain bids for the service in a manner identical to that provided for in Section 25-15-301, subsection (1)(a) and (b) except for those provisions which specifically state criteria which are applicable only to third-party administrators contracted with in accordance with Section 25-15-3 et seq.
(d) The board is also authorized to procure legal services if it deems these services to be necessary to carry out its responsibilities under Section 25-15-3 et seq.
SECTION 21. Section 25-15-7, Mississippi Code of 1972, is brought forward as follows:
25-15-7. Such health insurance shall not include expense incurred by or on account of an individual prior to July 1, 1972, as to him; dental care and treatment, except dental surgery and appliances to the extent necessary for the correction of damage caused by accidental injury while covered by the plan, or as a direct result of disease covered by the plan; eyeglasses, hearing aids for individuals over the age of twenty-one (21) years, and examinations for the prescription or fitting thereof; cosmetic surgery or treatment, except to the extent necessary for correction of damage by accidental injury while covered by the plan or as a direct result of disease covered by the plan; services received in a hospital owned or operated by the United States government for which no charge is made; services received for injury or sickness due to war or any act of war, whether declared or undeclared, which war or act of war shall have occurred after July 1, 1972; expense for which the individual is not required to make payment; expenses to the extent of benefits provided under any employer group plan other than this plan, in which the state participates in the cost thereof; and such other expenses as may be excluded by regulations of the board.
SECTION 22. Section 25-15-9, Mississippi Code of 1972, is brought forward as follows:
25-15-9. (1) (a) The board shall design a plan of health insurance for state employees that provides benefits for semiprivate rooms in addition to other incidental coverages that the board deems necessary. The amount of the coverages shall be in such reasonable amount as may be determined by the board to be adequate, after due consideration of current health costs in Mississippi. The plan shall also include major medical benefits in such amounts as the board determines. The plan shall provide for coverage for telemedicine services as provided in Section 83-9-351. The board is also authorized to accept bids for such alternate coverage and optional benefits as the board deems proper. The board is authorized to accept bids for surgical services that include assistance in locating a surgeon, setting up initial consultation, travel, a negotiated single case rate bundle and payment for orthopedic, spine, bariatric, cardiovascular and general surgeries. The surgical services may only utilize surgeons and facilities located in the State of Mississippi unless otherwise provided by the board. Any contract for alternative coverage and optional benefits shall be awarded by the board after it has carefully studied and evaluated the bids and selected the best and most cost-effective bid. The board may reject all of the bids; however, the board shall notify all bidders of the rejection and shall actively solicit new bids if all bids are rejected. The board may employ or contract for such consulting or actuarial services as may be necessary to formulate the plan, and to assist the board in the preparation of specifications and in the process of advertising for the bids for the plan. Those contracts shall be solicited and entered into in accordance with Section 25-15-5. The board shall keep a record of all persons, agents and corporations who contract with or assist the board in preparing and developing the plan. The board in a timely manner shall provide copies of this record to the members of the advisory council created in this section and those legislators, or their designees, who may attend meetings of the advisory council. The board shall provide copies of this record in the solicitation of bids for the administration or servicing of the self-insured program. Each person, agent or corporation that, during the previous fiscal year, has assisted in the development of the plan or employed or compensated any person who assisted in the development of the plan, and that bids on the administration or servicing of the plan, shall submit to the board a statement accompanying the bid explaining in detail its participation with the development of the plan. This statement shall include the amount of compensation paid by the bidder to any such employee during the previous fiscal year. The board shall make all such information available to the members of the advisory council and those legislators, or their designees, who may attend meetings of the advisory council before any action is taken by the board on the bids submitted. The failure of any bidder to fully and accurately comply with this paragraph shall result in the rejection of any bid submitted by that bidder or the cancellation of any contract executed when the failure is discovered after the acceptance of that bid. The board is authorized to promulgate rules and regulations to implement the provisions of this subsection.
The board shall develop plans for the insurance plan authorized by this section in accordance with the provisions of Section 25-15-5.
Any corporation, association, company or individual that contracts with the board for the third-party claims administration of the self-insured plan shall prepare and keep on file an explanation of benefits for each claim processed. The explanation of benefits shall contain such information relative to each processed claim that the board deems necessary, and, at a minimum, each explanation shall provide the claimant's name, claim number, provider number, provider name, service dates, type of services, amount of charges, amount allowed to the claimant and reason codes. The information contained in the explanation of benefits shall be available for inspection upon request by the board. The board shall have access to all claims information utilized in the issuance of payments to employees and providers.
(b) There is created an advisory council to advise the board in the formulation of the State and School Employees Health Insurance Plan. The council shall be composed of the State Insurance Commissioner, or his designee, an employee-representative of the institutions of higher learning appointed by the board of trustees thereof, an employee-representative of the Department of Transportation appointed by the director thereof, an employee-representative of the Department of Revenue appointed by the Commissioner of Revenue, an employee-representative of the Mississippi Department of Health appointed by the State Health Officer, an employee-representative of the Mississippi Department of Corrections appointed by the Commissioner of Corrections, and an employee-representative of the Department of Human Services appointed by the Executive Director of Human Services, two (2) certificated public school administrators appointed by the State Board of Education, two (2) certificated classroom teachers appointed by the State Board of Education, a noncertificated school employee appointed by the State Board of Education and a community/junior college employee appointed by the Mississippi Community College Board.
The Lieutenant Governor may designate the Secretary of the Senate, the Chairman of the Senate Appropriations Committee, the Chairman of the Senate Education Committee and the Chairman of the Senate Insurance Committee, and the Speaker of the House of Representatives may designate the Clerk of the House, the Chairman of the House Appropriations Committee, the Chairman of the House Education Committee and the Chairman of the House Insurance Committee, to attend any meeting of the State and School Employees Insurance Advisory Council. The appointing authorities may designate an alternate member from their respective houses to serve when the regular designee is unable to attend the meetings of the council. Those designees shall have no jurisdiction or vote on any matter within the jurisdiction of the council. For attending meetings of the council, the legislators shall receive per diem and expenses, which shall be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session; however, no per diem and expenses for attending meetings of the council will be paid while the Legislature is in session. No per diem and expenses will be paid except for attending meetings of the council without prior approval of the proper committee in their respective houses.
(c) No change in the terms of the State and School Employees Health Insurance Plan may be made effective unless the board, or its designee, has provided notice to the State and School Employees Health Insurance Advisory Council and has called a meeting of the council at least fifteen (15) days before the effective date of the change. If the State and School Employees Health Insurance Advisory Council does not meet to advise the board on the proposed changes, the changes to the plan shall become effective at such time as the board has informed the council that the changes shall become effective.
(d) Medical benefits for retired employees and dependents under age sixty-five (65) years and not eligible for Medicare benefits. For employees who retire before July 1, 2005, and for employees retiring due to work-related disability under the Public Employees' Retirement System, the same health insurance coverage as for all other active employees and their dependents shall be available to retired employees and all dependents under age sixty-five (65) years who are not eligible for Medicare benefits, the level of benefits to be the same level as for all other active participants. For employees who retire on or after July 1, 2005, and not retiring due to work-related disability under the Public Employees' Retirement System, the same health insurance coverage as for all other active employees and their dependents shall be available to those retiring employees and all dependents under age sixty-five (65) years who are not eligible for Medicare benefits only if the retiring employees were participants in the State and School Employees Health Insurance Plan for four (4) years or more before their retirement, the level of benefits to be the same level as for all other active participants. This section will apply to those employees who retire due to one hundred percent (100%) medical disability as well as those employees electing early retirement.
(e) Medical benefits for retired employees and dependents over age sixty-five (65) years or otherwise eligible for Medicare benefits. For employees who retire before July 1, 2005, and for employees retiring due to work-related disability under the Public Employees' Retirement System, the health insurance coverage available to retired employees over age sixty-five (65) years or otherwise eligible for Medicare benefits, and all dependents over age sixty-five (65) years or otherwise eligible for Medicare benefits, shall be the major medical coverage. For employees retiring on or after July 1, 2005, and not retiring due to work-related disability under the Public Employees' Retirement System, the health insurance coverage described in this paragraph (e) shall be available to those retiring employees only if they were participants in the State and School Employees Health Insurance Plan for four (4) years or more and are over age sixty-five (65) years or otherwise eligible for Medicare benefits, and to all dependents over age sixty-five (65) years or otherwise eligible for Medicare benefits. Benefits shall be reduced by Medicare benefits as though the Medicare benefits were the base plan.
All covered individuals shall be assumed to have full Medicare coverage, Parts A and B; and any Medicare payments under both Parts A and B shall be computed to reduce benefits payable under this plan.
(f) Lifetime maximum: The lifetime maximum amount of benefits payable under the health insurance plan for each participant is Two Million Dollars ($2,000,000.00).
(2) Nonduplication of benefits � reduction of benefits by Title XIX benefits: When benefits would be payable under more than one (1) group plan, benefits under those plans will be coordinated to the extent that the total benefits under all plans will not exceed the total expenses incurred.
Benefits for hospital or surgical or medical benefits shall be reduced by any similar benefits payable in accordance with Title XIX of the Social Security Act or under any amendments thereto, or any implementing legislation.
Benefits for hospital or surgical or medical benefits shall be reduced by any similar benefits payable by workers' compensation.
No health care benefits under the state plan shall restrict coverage for medically appropriate treatment prescribed by a physician and agreed to by a fully informed insured, or if the insured lacks legal capacity to consent by a person who has legal authority to consent on his or her behalf, based on an insured's diagnosis with a terminal condition. As used in this paragraph, "terminal condition" means any aggressive malignancy, chronic end-stage cardiovascular or cerebral vascular disease, or any other disease, illness or condition which physician diagnoses as terminal.
Not later than January 1, 2016, the state health plan shall not require a higher co-payment, deductible or coinsurance amount for patient-administered anti-cancer medications, including, but not limited to, those orally administered or self-injected, than it requires for anti-cancer medications that are injected or intravenously administered by a health care provider, regardless of the formulation or benefit category determination by the plan. For the purposes of this paragraph, the term "anti-cancer medications" has the meaning as defined in Section 83-9-24.
(3) (a) Schedule of life insurance benefits � group term: The amount of term life insurance for each active employee of a department, agency or institution of the state government shall not be in excess of One Hundred Thousand Dollars ($100,000.00), or twice the amount of the employee's annual wage to the next highest One Thousand Dollars ($1,000.00), whichever may be less, but in no case less than Thirty Thousand Dollars ($30,000.00), with a like amount for accidental death and dismemberment on a twenty-four-hour basis. The plan will further contain a premium waiver provision if a covered employee becomes totally and permanently disabled before age sixty-five (65) years. Employees retiring after June 30, 1999, shall be eligible to continue life insurance coverage in an amount of Five Thousand Dollars ($5,000.00), Ten Thousand Dollars ($10,000.00) or Twenty Thousand Dollars ($20,000.00) into retirement.
(b) Effective October 1, 1999, schedule of life insurance benefits � group term: The amount of term life insurance for each active employee of any school district, community/junior college, public library or university-based program authorized under Section 37-23-31 for deaf, aphasic and emotionally disturbed children or any regular nonstudent bus driver shall not be in excess of One Hundred Thousand Dollars ($100,000.00), or twice the amount of the employee's annual wage to the next highest One Thousand Dollars ($1,000.00), whichever may be less, but in no case less than Thirty Thousand Dollars ($30,000.00), with a like amount for accidental death and dismemberment on a twenty-four-hour basis. The plan will further contain a premium waiver provision if a covered employee of any school district, community/junior college, public library or university-based program authorized under Section 37-23-31 for deaf, aphasic and emotionally disturbed children or any regular nonstudent bus driver becomes totally and permanently disabled before age sixty-five (65) years. Employees of any school district, community/junior college, public library or university-based program authorized under Section 37-23-31 for deaf, aphasic and emotionally disturbed children or any regular nonstudent bus driver retiring after September 30, 1999, shall be eligible to continue life insurance coverage in an amount of Five Thousand Dollars ($5,000.00), Ten Thousand Dollars ($10,000.00) or Twenty Thousand Dollars ($20,000.00) into retirement.
(4) Any eligible employee who on March 1, 1971, was participating in a group life insurance program that has provisions different from those included in this article and for which the State of Mississippi was paying a part of the premium may, at his discretion, continue to participate in that plan. The employee shall pay in full all additional costs, if any, above the minimum program established by this article. Under no circumstances shall any individual who begins employment with the state after March 1, 1971, be eligible for the provisions of this subsection.
(5) The board may offer medical savings accounts as defined in Section 71-9-3 as a plan option.
(6) Any premium differentials, differences in coverages, discounts determined by risk or by any other factors shall be uniformly applied to all active employees participating in the insurance plan. It is the intent of the Legislature that the state contribution to the plan be the same for each employee throughout the state.
(7) On October 1, 1999, any school district, community/junior college district or public library may elect to remain with an existing policy or policies of group life insurance with an insurance company approved by the State and School Employees Health Insurance Management Board, in lieu of participation in the State and School Life Insurance Plan. On or after July 1, 2004, until October 1, 2004, any school district, community/junior college district or public library may elect to choose a policy or policies of group life insurance existing on October 1, 1999, with an insurance company approved by the State and School Employees Health Insurance Management Board in lieu of participation in the State and School Life Insurance Plan. The state's contribution of up to fifty percent (50%) of the active employee's premium under the State and School Life Insurance Plan may be applied toward the cost of coverage for full-time employees participating in the approved life insurance company group plan. For purposes of this subsection (7), "life insurance company group plan" means a plan administered or sold by a private insurance company. After October 1, 1999, the board may assess charges in addition to the existing State and School Life Insurance Plan rates to such employees as a condition of enrollment in the State and School Life Insurance Plan. In order for any life insurance company group plan to be approved by the State and School Employees Health Insurance Management Board under this subsection (7), it shall meet the following criteria:
(a) The insurance company offering the group life insurance plan shall be rated "A-" or better by A.M. Best state insurance rating service and be licensed as an admitted carrier in the State of Mississippi by the Mississippi Department of Insurance.
(b) The insurance company group life insurance plan shall provide the same life insurance, accidental death and dismemberment insurance and waiver of premium benefits as provided in the State and School Life Insurance Plan.
(c) The insurance company group life insurance plan shall be fully insured, and no form of self-funding life insurance by the company shall be approved.
(d) The insurance company group life insurance plan shall have one (1) composite rate per One Thousand Dollars ($1,000.00) of coverage for active employees regardless of age and one (1) composite rate per One Thousand Dollars ($1,000.00) of coverage for all retirees regardless of age or type of retiree.
(e) The insurance company and its group life insurance plan shall comply with any administrative requirements of the State and School Employees Health Insurance Management Board. If any insurance company providing group life insurance benefits to employees under this subsection (7) fails to comply with any requirements specified in this subsection or any administrative requirements of the board, the state shall discontinue providing funding for the cost of that insurance.
SECTION 23. Section 25-15-11, Mississippi Code of 1972, is brought forward as follows:
25-15-11. (1) The board is authorized to execute a contract or contracts to provide the benefits under the plan. Such contract or contracts may be executed with one or more corporations or associations licensed to transact life and accident and health insurance business in this state; however, no such contract shall be executed with any corporation, association or company domiciled in any other state except that such corporation, association or company shall meet the conditions and terms for a like contract established by the state of the domicile of such corporation, association or company for a Mississippi corporation, association or company. No corporation, association or company with less than five (5) years' experience in the life and health field may bid. All of the benefits to be provided under the plan may be included in one or more similar contracts, or the benefits may be classified into different types with each type included under one or more similar contracts issued by the same or different companies.
The board shall supply the statistical information upon which a quotation is to be calculated, upon request, to all carriers licensed in the state. Bids may be accepted at the discretion of the board, and the board shall have the right to adjust rates on an annual basis if the board shall deem such adjustment necessary. The plan for active employees shall be on retention accounting basis, and a separate retention accounting basis shall be used for retired employees. Any additional written information the carrier wishes to submit, supporting the proposed benefits and premium rate, may accompany the proposal. After receiving the proposals, the board shall determine whether to contract with the carrier which has been determined to have submitted the lowest and best bid, or to reject all such bids and receive new proposals.
The board shall authorize any corporation licensed to transact accident and health insurance business in this state issuing any such contract to reinsure portions of such contract with any other such corporation which elected to be a reinsurer and is legally competent to enter into a reinsurance agreement. The board may designate one or more of such corporations as the administering corporation or corporations. Each employee who is covered under any such contract or contracts shall receive a certificate setting forth the benefits to which the employee is entitled thereunder, to whom such benefits shall be payable, to whom claims should be submitted, and summarizing the provisions of the contract principally affecting the employee. Such certificate shall be in lieu of the certificate which the corporation or corporations issuing such contract or contracts would otherwise issue.
The board may, as of the end of any contract year, discontinue any contract or contracts it has executed with any corporation or corporations and replace it or them with a contract or contracts in any other corporation or corporations meeting the requirements of this section.
The board may reject any and all bids and contracts under this section and may elect for the state to become a self-insurer; however, administration and service of any such self-insured program may be contracted to a third party by the board.
Any contract with a third party to administer the plan shall be bid and entered into in accordance with the procedures provided in Section 25-15-301.
(2) By September 30 of each year, the board shall report to the Joint Legislative Budget Committee, Senate Insurance Committee, House Insurance Committee, Senate Education Committee, House Education Committee and Joint Legislative Committee on Performance Evaluation and Expenditure Review the condition of the State and School Employees Life and Health Insurance Plan. Such report shall contain for the most recently completed fiscal year, but not be limited to, the following:
(a) The plan's financial condition at the close of the fiscal year.
(b) The history of yearly claims paid and premiums received for each premium class, including, but not limited to, active employees, dependents and retirees.
(c) The history of loss ratios for the active employees, dependents and retirees premium classes as well as historical trend of such ratios. For the purposes of this section, the term "loss ratios" means claims paid by the plan for each premium class divided by premiums received by the plan for insurance coverage of the members in that premium class.
(d) Budgetary information, including:
(i) A detailed breakdown of all expenditures of the plan, administrative and otherwise, for the most recently completed fiscal year and projected expenditures, administrative and otherwise, for the current and next fiscal year;
(ii) A schedule of all contracts, administrative and otherwise, executed for the benefit of the plan during the most recent completed fiscal year and those executed and anticipated for the current fiscal year; and
(iii) A description of the processes used by the board to procure all contracts, administrative and otherwise, as well as a description of the scope of services to be provided by each contractor.
Budgetary information shall be provided in a format designated by the Joint Legislative Budget Committee.
The Joint Legislative Budget Committee, Senate Insurance Committee, House Insurance Committee, Senate Education Committee, House Education Committee and Joint Legislative Committee on Performance Evaluation and Expenditure Review may request additional information or reports from the board on an as-needed basis.
(3) Annually, the board shall request, and the Department of Audit shall conduct, a comprehensive audit of the State and School Employees Life and Health Insurance Plan. For purposes of this section, the audit required herein shall be separate and distinct from any audit prepared in conjunction with the development of the Comprehensive Annual Financial Report (CAFR).
SECTION 24. Section 25-15-13, Mississippi Code of 1972, is brought forward as follows:
25-15-13. Each eligible employee may participate in the plan by signing up for the plan at the time of employment. Each eligible employee who declines coverage under the plan must sign a waiver of coverage. After acceptance in the plan, the employee may cease his or her participation by filing a specific disclaimer with the board. Forms for this purpose shall be prescribed and issued by the board. All eligible employees will be eligible to participate in the plan on the effective date of the plan or on the date on which they are employed by the state, whichever is later, provided they make the necessary contributions as provided in this article. Spouses of employees, unmarried dependent children from birth to age nineteen (19) years, unmarried dependent children who are full-time students up to age twenty-five (25) years, and children with physical or mental disabilities, regardless of age, are eligible under the plan as of the date the employee becomes eligible. If both spouses are eligible employees who participate in the plan, the benefits shall apply individually to each spouse by virtue of his or her participation in the plan. If those spouses also have one or more eligible dependents participating in the plan, the cost of their dependents shall be calculated at a special family plan rate. The cost for participation by the dependents shall be paid by the spouse who elects to carry such dependents under his or her coverage.
SECTION 25. Section 25-15-14, Mississippi Code of 1972, is brought forward as follows:
25-15-14. Any elected state or district official who does not run for reelection or who is defeated before being entitled to receive a retirement allowance shall be eligible to continue to participate in the State and School Employees Health Insurance Plan under the same conditions and coverages for retired employees.
SECTION 26. Section 25-15-15, Mississippi Code of 1972, is brought forward as follows:
25-15-15. (1) The board is authorized to determine the manner in which premiums and contributions by the state agencies, local school districts, colleges, universities, community/junior colleges and public libraries shall be collected to provide the self-insured health insurance program for employees as provided under this article. The state shall provide fifty percent (50%) of the cost of the above life insurance plan for all active full-time employees. The state shall provide one hundred percent (100%) of the cost of the health insurance plan for active full-time employees initially employed before January 1, 2006, except as otherwise provided in this section. For active full-time employees initially employed on or after January 1, 2006, the state shall provide one hundred percent (100%) of the cost of a basic level of health insurance, except as otherwise provided in this section, and the employees may pay additional amounts to purchase additional benefits or levels of coverage offered under the plan. The board, if determined to be necessary, may assess active full-time employees a portion of the active employee premium in an amount not to exceed Twenty Dollars ($20.00) per month, notwithstanding any language in this section to the contrary. All active full-time employees shall be given the opportunity to purchase coverage for their eligible dependents with the premiums for such dependent coverage, as well as the employee's fifty percent (50%) share for his life insurance coverage, to be deductible from the employee's salary by the agency, department or institution head, which deductions, together with the fifty percent (50%) share of such life insurance premiums of such employing agency, department or institution head from funds appropriated to or authorized to be expended by the employing agency, department or institution head, shall be deposited directly into a depository bank or special fund in the State Treasury, as determined by the board. These funds and interest earned on these funds may be used for the disbursement of claims and shall be exempt from the appropriation process.
(2) The state shall provide annually, by line item in the Mississippi Library Commission appropriation bill, such funds to pay one hundred percent (100%) of the cost of health insurance under the State and School Employees Health Insurance Plan, or any lesser percentage of the cost that is not assessed to the employees by the board, for full-time library staff members in each public library in Mississippi initially employed before January 1, 2006. For full-time library staff members initially employed on or after January 1, 2006, the state shall provide one hundred percent (100%) of the cost of a basic level of health insurance under the State and School Employees Health Insurance Plan, or any lesser percentage of the cost that is not assessed to the employees by the board, and the employees may pay additional amounts to purchase additional benefits or levels of coverage offered under the plan. The commission shall allot to each public library a sufficient amount of those funds appropriated to pay the costs of insurance for eligible employees. Any funds so appropriated by line item which are not expended during the fiscal year for which such funds were appropriated shall be carried forward for the same purposes during the next succeeding fiscal year. If any premiums for the health insurance and/or late charges and interest penalties are not paid by a public library in a timely manner, as defined by the board, the Mississippi Library Commission, upon notice by the board, shall immediately withhold all subsequent disbursements of funds to that public library.
(3) The state shall annually provide one hundred percent (100%) of the cost of the health insurance plan, or any lesser percentage of the cost that is not assessed to the employees by the board, for public school district employees who work no less than twenty (20) hours during each week and regular nonstudent school bus drivers, if such employees and school bus drivers were initially employed before January 1, 2006. For such employees and school bus drivers initially employed on or after January 1, 2006, the state shall provide one hundred percent (100%) of the cost of a basic level of health insurance under the State and School Employees Health Insurance Plan, or any lesser percentage of the cost that is not assessed to the employees by the board, and the employees may pay additional amounts to purchase additional benefits or levels of coverage offered under the plan. Where federal funding is allowable to defray, in full or in part, the cost of participation in the program by district employees who work no less than twenty (20) hours during the week and regular nonstudent bus drivers, whose salaries are paid, in full or in part, by federal funds, the allowance under this section shall be reduced to the extent of such federal funding. Where the use of federal funds is allowable but not available, it is the intent of the Legislature that school districts contribute the cost of participation for such employees from local funds, except that parent fees for child nutrition programs shall not be increased to cover such cost.
(4) The state shall provide annually, by line item in the community/junior college appropriation bill, such funds to pay one hundred percent (100%) of the cost of the health insurance plan, or any lesser percentage of the cost that is not assessed to the employees by the board, for community/junior college district employees initially employed before January 1, 2006, who work no less than twenty (20) hours during each week. For such employees initially employed on or after January 1, 2006, the state shall provide one hundred percent (100%) of the cost of a basic level of health insurance under the State and School Employees Health Insurance Plan, or any lesser percentage of the cost that is not assessed to the employees by the board, and the employees may pay additional amounts to purchase additional benefits or levels of coverage offered under the plan.
(5) When the use of federal funding is allowable to defray, in full or in part, the cost of participation in the insurance plan by community/junior college district employees who work no less than twenty (20) hours during each week, whose salaries are paid, in full or in part, by federal funds, the allowance under this section shall be reduced to the extent of the federal funding. Where the use of federal funds is allowable but not available, it is the intent of the Legislature that community/junior college districts contribute the cost of participation for such employees from local funds.
(6) Any community/junior college district may contribute to the cost of coverage for any district employee from local community/junior college district funds, and any public school district may contribute to the cost of coverage for any district employee from nonminimum program funds. Any part of the cost of such coverage for participating employees of public school districts and public community/junior college districts that is not paid by the state shall be paid by the participating employees, which shall be deducted from the salaries of the employees in a manner determined by the board.
(7) Any funds appropriated for the cost of insurance by line item in the community/junior colleges appropriation bill which are not expended during the fiscal year for which such funds were appropriated shall be carried forward for the same purposes during the next succeeding fiscal year.
(8) The board may establish and enforce late charges and interest penalties or other penalties for the purpose of requiring the prompt payment of all premiums for life and health insurance permitted under this chapter. All funds in excess of the amount needed for disbursement of claims shall be deposited in a special fund in the State Treasury to be known as the State and School Employees Insurance Fund. The State Treasurer shall invest all funds in the State and School Employees Insurance Fund and all interest earned shall be credited to the State and School Employees Insurance Fund. Such funds shall be placed with one or more depositories of the state and invested on the first day such funds are available for investment in certificates of deposit, repurchase agreements or in United States Treasury bills or as otherwise authorized by law for the investment of Public Employees' Retirement System funds, as long as such investment is made from competitive offering and at the highest and best market rate obtainable consistent with any available investment alternatives; however, such investments shall not be made in shares of stock, common or preferred, or in any other investments which would mature more than one (1) year from the date of investment. The board shall have the authority to draw from this fund periodically such funds as are necessary to operate the self-insurance plan or to pay to the insurance carrier the cost of operation of this plan, it being the purpose to limit the amount of participation by the state to fifty percent (50%) of the cost of the life insurance program and not to limit the contracting for additional benefits where the cost will be paid in full by the employee. The state shall not share in the cost of coverage for retired employees.
(9) The board shall also provide for the creation of an Insurance Reserve Fund and funds therein shall be invested by the State Treasurer with all interest earned credited to the State and School Employees Insurance Fund.
(10) Any retired employee electing to purchase retired life and health insurance will have the full cost of such insurance deducted monthly from his State of Mississippi retirement plan check or direct billed for the cost of the premium if the retirement check is insufficient to pay for the premium. If the board determines actuarially that the premium paid by the participating retirees adversely affects the overall cost of the plan to the state, then the board may impose a premium surcharge, not to exceed fifteen percent (15%), upon such participating retired employees who are under the age for Medicare eligibility and who were initially employed before January 1, 2006. For participating retired employees who are under the age for Medicare eligibility and who were initially employed on or after January 1, 2006, the board may impose a premium surcharge in an amount the board determines actuarially to cover the full cost of insurance.
(11) This section shall stand repealed on July 1, 2026.
SECTION 27. Section 25-15-16, Mississippi Code of 1972, is brought forward as follows:
25-15-16. The public school districts of the state, in their discretion, may pay with local funds one hundred percent (100%) of the cost of the health insurance premiums of the State and School Employees Health Insurance Plan for all retired members of the Public Employees' Retirement System who are employed as school bus drivers by the school districts. No state funds shall be used for payment of the health insurance premiums under the authority of this section. If a school district chooses to pay the health insurance premiums for school bus drivers under the authority of this section, the district shall be authorized to pay any amount that is one hundred percent (100%) or less of the cost of the health insurance premiums for the school bus drivers.
SECTION 28. Section 25-15-17, Mississippi Code of 1972, is brought forward as follows:
25-15-17. (1) Any benefits payable under the plan may be made either directly to the attending physicians, hospitals, medical groups, or others furnishing the services upon which a claim is based, or to the covered employee, upon presentation of valid bills for such services, subject to subsection (3) of this section and such provisions to facilitate payment as may be made by the board. All benefits payable under this plan shall be payable directly to the covered employee unless such covered employee shall make a valid assignment in accordance with subsection (3) of this section.
(2) The plan may not, by its terms, limit or restrict the covered employee's ability to assign the covered employee's benefits under the policy to a licensed health care provider that provides health care services to the covered employee. Any such plan provision in violation of this subsection shall be invalid.
(3) If the covered employee provides the board with written direction that all or a portion of any indemnities or benefits provided by the plan be paid to a licensed health care provider rendering hospital, nursing, medical or surgical services, then the plan shall pay directly the licensed health care provider rendering such services. That payment shall be considered payment in full to the provider, who may not bill or collect from the covered employee any amount above that payment, other than the deductible, coinsurance, copayment or other charges for equipment or services requested by the covered employee that are noncovered benefits after the signing of an explanatory document about the noncovered benefit by the covered employee.
SECTION 29. Section 25-15-19, Mississippi Code of 1972, is brought forward as follows:
25-15-19. On or before July 1, 1972, the board shall notify all department, agency and institution heads that the employee deductions shall commence on said date.
SECTION 30. Section 25-15-23, Mississippi Code of 1972, is brought forward as follows:
25-15-23. No agency, board, school district, community/junior college, public library, university, institution or authority of the state shall withdraw, or authorize any agency or institution under its management and control to withdraw, from the State and School Employees Life and Health Insurance Plan established under this chapter.
SECTION 31. Section 41-149-5, Mississippi Code of 1972, is brought forward as follows:
(a) Reimburse a 340B entity for 340B drugs at a rate lower than that paid for the same drug to entities that are not 340B entities or lower reimbursement for a claim on the basis that the claim is for a 340B drug.
(b) Impose any terms or conditions on any 340B entity with respect to any of the following that differ from such terms or conditions applied to non-340B entities on the basis that the entity participates in the federal 340B drug discount program set forth in 42 USC 256b or that a drug is a 340B drug including, without limitation, any of the following:
(i) Fees, charges, clawbacks, or other adjustments or assessments. For purposes of this item 1, the term "other adjustment" includes placing any additional requirements, restrictions, or unnecessary burdens upon the 340B entity that results in administrative costs or fees to the 340B entity that are not placed upon other entities that do not participate in the 340B drug discount program, including affiliate pharmacies of the health insurance issuer, pharmacy benefit manager, or other third-party payor.
(ii) Dispensing fees that are less than the dispensing fees for non-340B entities.
(iii) Restrictions or requirements regarding participation in standard or preferred pharmacy networks.
(iv) Requirements relating to the frequency or scope of audits of inventory management systems.
(v) Requirements that a claim for a drug include any identification, billing modifier, attestation, or other indication that a drug is a 340B drug in order to be processed or resubmitted unless it is required by the Centers for Medicare and Medicaid Services or the Division of Medicaid for the administration of the Mississippi Medicaid program.
(vi) Any other restrictions, conditions, practices, or policies that are not imposed on non-340B entities.
(c) Require a 340B entity to reverse, resubmit, or clarify a claim after the initial adjudication unless these actions are in the normal course of pharmacy business and not related to 340B drug pricing.
(d) Discriminate against a 340B entity in a manner that prevents or interferes with any patient's choice to receive such drugs from the 340B entity, including the administration of such drugs. For purposes of this subparagraph (iv), it is considered a discriminatory practice that prevents or interferes with a patient's choice to receive drugs at a 340B entity if a health insurance issuer, pharmacy benefit manager, or other third-party payor places any additional requirements, restrictions, or unnecessary burdens upon the 340B entity that results in administrative costs or fees to the 340B entity, including but not limited to requiring a claim for a drug to include any identification, billing modifier, attestation or other indication that a drug is a 340B drug in order to be processed or resubmitted unless it is required by the Centers for Medicare and Medicaid Services or the Division of Medicaid in administration of the Mississippi Medicaid program.
(e) Include any other provision in a contract between a health insurance issuer, pharmacy benefit manager, or other third-party payor and a 340B entity that discriminates against the 340B entity or prevents or interferes with an individual's choice to receive a prescription drug from a 340B entity, including the administration of the drug, in person or via direct delivery, mail, or other form of shipment, or creation of a restriction or additional charge on a patient who chooses to receive drugs from a 340B entity.
(f) Require or compel the submission of ingredient costs or pricing data pertaining to 340B drugs to any health insurance issuer, pharmacy benefit manager, or other third-party payor.
(g) Exclude any 340B entity from the health insurance issuer, pharmacy benefit manager, or other third-party payor network on the basis that the 340B entity dispenses drugs subject to an agreement under 42 USC 256b, or refusing to contract with a 340B entity for reasons other than those that apply equally to non-340B entities.
(2) Nothing in this chapter applies to the Mississippi Medicaid program as payor when Medicaid provides reimbursement for covered outpatient drugs as defined in 42 USC 1396r-8(k).
SECTION 32. Section 41-151-7, Mississippi Code of 1972, is brought forward as follows:
41-151-7. (1) A health insurance issuer, pharmacy benefit manager, or the agent of either shall not:
(a) Refuse to authorize, approve, or pay a participating provider for providing covered physician-administered drugs and related covered services to covered persons; or
(b) Require a covered person to pay any penalty or additional fee not otherwise applicable to cost-sharing amounts payable by the covered person as designated within the benefit plan to obtain the physician-administered drug when provided by a participating provider.
(2) All provider agreements are hereby construed to include a provision that requires that when all criteria for medical necessity are met, that the drug and its administration will be payable irrespective of whether the participating provider obtains physician-administered drugs from a pharmacy that is not a participating provider in the health insurance issuer's network. The drug supplied shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act.
(3) The payment to a participating provider shall be at the rate set forth in the health insurance issuer's agreement with the participating provider applicable to such drugs, or if no such rate is included in the agreement, then at the wholesale acquisition cost.
(4) Any provision of a contract that is contrary to any provision of this chapter shall be null, void, and unenforceable in this state.
SECTION 33. Section 73-21-205, Mississippi Code of 1972, is brought forward as follows:
73-21-205. (1) (a) Pharmacists may provide additional information to a patient to allow them an opportunity to consider affordable alternative payment options when acquiring their prescription medication.
(b) Any provision of any contract or agreement contrary to the provisions of Sections 73-21-201 through 73-21-205 shall be considered in violation of public policy and shall be void.
(2) Compliance with this section shall not constitute a violation of any contract or provision of any agreement to which the pharmacist or pharmacy is a party.
(3) Neither the board, any pharmacy benefit manager nor any third party shall penalize a pharmacist for acting or failing to act under this section, nor shall a pharmacist or his agents or employees be liable for any act or failure to act under this section.
SECTION 34. If the application or operation of any section, subsection, paragraph, sentence, clause, word or provision of this act shall be enjoined or otherwise made inoperative by a court of competent jurisdiction on the grounds that state or federal law invalidates the application or operation thereof, this act shall be valid and effective in all other applications and operations, and no section, subsection, paragraph, sentence, clause, word or other provision shall on account of any pending litigation be deemed invalid or ineffective except as to that language which has been enjoined or otherwise made inoperative, then only until the injunction is removed.
SECTION 35. This act shall take effect and be in force from and after July 1, 2026.
Further, amend by striking the title in its entirety and inserting in lieu thereof the following:
AN ACT TO REVISE THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE NEW SECTIONS ADDED TO 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 CERTAIN EXISTING TERMS; TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO REVISE THE REIMBURSEMENT AMOUNT FROM PHARMACY BENEFIT MANAGERS AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS (PSAOS) PAYABLE TO PHARMACIES; TO REQUIRE PHARMACY BENEFIT MANAGERS TO GIVE PHARMACISTS REASONS FOR DENYING A CLAIM WITHIN SEVEN DAYS OF RECEIVING AN ELECTRONIC CLAIM; TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO DELETE PROVISIONS AUTHORIZING PHARMACY BENEFIT MANAGERS FROM USING MAXIMUM ALLOWABLE COST LISTS; TO REVISE THE ADMINISTRATIVE APPEALS PROCESS PHARMACY BENEFIT MANAGERS MUST MAKE AVAILABLE TO PHARMACIES TO CHALLENGE REIMBURSEMENTS; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE PSAOS TO BE LICENSED BY THE STATE BOARD OF PHARMACY; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO RENEW LICENSES ANNUALLY; TO REVISE THE FINANCIAL DOCUMENTS THAT MUST BE SUBMITTED TO THE BOARD WITH AN APPLICATION FOR A LICENSE OR LICENSE RENEWAL; TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT THE USE OF SPREAD PRICING BY PHARMACY BENEFIT MANAGERS; TO BRING FORWARD SECTION 73-21-159, MISSISSIPPI CODE OF 1972, WHICH RELATES TO FINANCIAL EXAMINATIONS OF PHARMACY BENEFIT MANAGERS, FOR PURPOSES OF POSSIBLE AMENDMENT; TO AMEND SECTION 73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT STEERING BY PHARMACY BENEFIT MANAGERS; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT RETALIATION AGAINST PHARMACISTS BY PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PSAOS; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO REVISE PROVISIONS RELATING TO INVESTIGATIONS AND AUDITS OF PHARMACY BENEFIT MANAGERS CONDUCTED BY THE BOARD; TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO SUBMIT CERTAIN ANNUAL REPORTS TO THE BOARD; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO CREATE THE MISSISSIPPI SPECIALTY DRUG COMMITTEE; TO CREATE NEW SECTION 73-21-211, MISSISSIPPI CODE OF 1972, TO DESIGNATE CERTAIN NEWLY CREATED STATUTES AS THE PHARMACY FAIR COMPETITION ACT; TO CREATE NEW SECTION 73-21-213, MISSISSIPPI CODE OF 1972, TO DECLARE CERTAIN LEGISLATIVE FINDINGS RELATING TO THE DISTRIBUTION AND RETAIL SALE OF PHARMACEUTICAL DRUGS AND THE PUBLIC NECESSITY TO REGULATE AND LICENSE CERTAIN PHARMACEUTICAL INDUSTRIES; TO CREATE NEW SECTION 73-15-215, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS FROM HOLDING A PHARMACY PERMIT FOR THE RETAIL SALE OF DRUGS; TO AUTHORIZE THE BOARD TO ISSUE LIMITED USE PERMITS FOR THE SALE OF RARE DRUGS UNDER CERTAIN CIRCUMSTANCES; TO CREATE NEW SECTION 73-21-217, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD TO ASSESS EACH ACTIVE RETAIL PHARMACY PERMIT TO DETERMINE IF THE PERMIT HOLDER IS IN VIOLATION OF SECTION 73-21-215, MISSISSIPPI CODE OF 1972; TO AMEND SECTION 25-15-301, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE STATE AND SCHOOL EMPLOYEES LIFE AND HEALTH INSURANCE PLAN TO CONTRACT FOR THE MANAGEMENT OF PHARMACY BENEFITS; TO REQUIRE THE EXECUTIVE DIRECTOR OF THE STATE BOARD OF PHARMACY TO BE A MEMBER OF THE EVALUATION COMMITTEE WHEN CONSIDERING PROPOSALS FOR SUCH ADMINISTRATION; TO REQUIRE A PHARMACY BENEFITS MANAGER FOR THE STATE HEALTH PLAN TO COMPLY WITH THE PROVISIONS OF THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 25-15-303, MISSISSIPPI CODE OF 1972, TO ADD THE EXECUTIVE DIRECTOR OF THE STATE BOARD OF PHARMACY TO THE MEMBERSHIP OF THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD; TO BRING FORWARD SECTIONS 25-15-3, 25-15-5, 25-15-7, 25-15-9, 25-15-11, 25-15-13, 25-15-14, 25-15-15, 25-15-16, 25-15-17, 25-15-19, 25-15-23, 41-149-5, 41-151-7 AND 73-21-205, MISSISSIPPI CODE OF 1972, FOR THE PURPOSES OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES.
