Bill Text: MS SB2323 | 2021 | Regular Session | Introduced
Bill Title: Mississippi Health Care Cost Transparency Act; enact.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2021-02-02 - Died In Committee [SB2323 Detail]
Download: Mississippi-2021-SB2323-Introduced.html
MISSISSIPPI LEGISLATURE
2021 Regular Session
To: Insurance
By: Senator(s) Hill
Senate Bill 2323
AN ACT TO CREATE THE MISSISSIPPI HEALTH CARE COST TRANSPARENCY ACT; TO DEFINE TERMS USED IN THE ACT; TO REQUIRE EACH DRUG MANUFACTURER TO ANNUALLY DISCLOSE PRESCRIPTION DRUG PRICING INFORMATION TO THE COMMISSIONER OF INSURANCE AND TO REQUIRE THE COMMISSIONER TO DEVELOP A WEBSITE TO CONTAIN PRESCRIPTION DRUG PRICE INFORMATION; TO REQUIRE PHARMACY BENEFITS MANAGERS TO ANNUALLY DISCLOSE TO THE COMMISSIONER OF INSURANCE CERTAIN PHARMACY BENEFIT MANAGEMENT INFORMATION; TO REQUIRE HEALTH INSURERS TO ANNUALLY SUBMIT A REPORT TO THE COMMISSIONER REGARDING PRESCRIPTION DRUG PRICE INFORMATION; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. This act shall be known and may be cited as the "Mississippi Health Care Cost Transparency Act."
SECTION 2. The purpose of this act is to promote prescription drug price transparency and cost control.
SECTION 3. As used in this act, unless the context clearly indicates otherwise:
(a) "Board of Pharmacy" or "board" means the Mississippi Board of Pharmacy.
(b) "Commissioner" means the Insurance Commissioner.
(c) "Department" means the Mississippi Department of Insurance.
(d) "Director" means the Executive Director of the Division of Medicaid.
(e) "Drug" means:
(i) Articles recognized in the official United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States or official National Formulary, or any supplement to any of them;
(ii) Articles intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in humans or other animals;
(iii) Articles, other than food, intended to affect the structure or any function of the body of humans or any other animal; and
(iv) Articles intended for use as a component of any articles specified in this paragraph (e); but shall not include devices or their components, parts or accessories;
(f) "Health care plan" means any individual, blanket, or group plan, policy, or contract for health care services issued or delivered by a health insurer in this state.
(g) "Health carrier" or "health insurer" means an insurance company, a health maintenance organization, or a hospital and medical service corporation.
(h) "Net spending" means the cost of prescription drugs minus any discounts that lowers the price of the drugs, including, but not limited to, rebates, fees, retained price protections, retail pharmacy network spread, and dispensing fees.
(i) "Pharmacist services" means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.
(j) "Pharmacy benefits manager" means any person who administers the prescription drug, prescription device, pharmacist services or prescription drug and device and pharmacist services portion of a health care plan offered in the state on behalf of an insurer.
(k) "Rebate" means any discount or concession which affects the price of a prescription drug to a pharmacy benefits manager or health insurer for a prescription drug manufactured by the pharmaceutical manufacturer.
(l) "Specialty drug" means a prescription drug outpatient specialty drug covered under the Medicare Part D program established pursuant to Public Law 108-73, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as amended from time to time, that exceeds the specialty tier cost threshold established by the Centers for Medicare and Medicaid Services.
(m) "Utilization management" means a set of formal techniques designed to monitor the use of, or evaluate the medical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings.
(n) "Wholesale acquisition cost" means, with respect to a pharmaceutical drug or biological product, the manufacturer's list price for the pharmaceutical drug or biological product to wholesalers or direct purchasers in the United States for the most recent month for which the information is available, as reported in wholesale price guides or other publications of pharmaceutical drug or biological product pricing data, not including any rebates, prompt pay or other discounts, or other reductions in price.
SECTION 4. (1) (a) Not later than January 1, 2022, and annually thereafter, each drug manufacturer shall submit a report to the Commissioner of Insurance no later than the fifteenth day of January, April, July, and October with the current wholesale acquisition cost information for the United States Food and Drug Administration approved drugs sold in or into the state by that manufacturer.
(b) The commissioner shall develop a website to contain prescription drug price information submitted pursuant to paragraph (a) of this subsection. The website shall be made available on the Department of Insurance website with a dedicated link that is prominently displayed on the home page, or by a separate easily identifiable internet address.
(2) (a) Not more than thirty (30) days after an increase in wholesale acquisition cost of fifty percent (50%) or greater for a drug with a wholesale acquisition cost of One Hundred Dollars ($100.00) or more for a thirty-day supply, a pharmaceutical drug manufacturer shall submit a report to the Commissioner of Insurance. The report shall contain the following information:
(i) Name of the product;
(ii) Whether the drug is a brand name or a generic;
(iii) The effective date of the change in wholesale acquisition cost;
(iv) Aggregate, company-level research and development costs for the prior calendar year;
(v) The name of each of the manufacturer's prescription drugs that was approved by the federal Food and Drug Administration in the previous five (5) calendar years; and
(vi) The name of each of the manufacturer's prescription drugs that lost patent exclusivity in the United States in the previous five (5) calendar years.
(b) The quality and types of information and data that a pharmaceutical manufacturer submits to the commissioner pursuant to this subsection shall be consistent with the quality and types of information and data that the manufacturer includes in their annual consolidated report on Securities and Exchange Commission Form 10-K or any other public disclosure.
(c) Within sixty (60) days of receipt, the commissioner shall publish the report on the Department of Insurance prescription drug price information website developed pursuant to subsection (1)(b) of this section.
(3) A manufacturer shall notify the commissioner in writing if it is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D program. The manufacturer shall provide the written notice within three (3) calendar days following the release of the drug in the commercial market. A manufacturer may make the notification pending approval by the United States Food and Drug Administration (FDA) if commercial availability is expected within three (3) calendar days following the approval.
(4) The commissioner may adopt regulations to implement the provisions of this section.
SECTION 5. (1) (a) Not later than February 1, 2022, and annually thereafter, each pharmacy benefits manager shall file a report with the commissioner. The report shall contain the following information for the immediately preceding calendar year: (i) The aggregated rebates, fees, price protection payments, and any other payments collected from pharmaceutical manufacturers;
(ii) The aggregated dollar amount of rebates, price protection payments, fees and any other payments collected from pharmaceutical manufacturers that were passed to health insurers;
(iii) The aggregated dollar amount of rebates, price protection payments, fees and any other payments collected from pharmaceutical manufacturers that were passed to enrollees at the point of sale.
(b) Reports submitted by pharmacy benefit managers shall not disclose the identity of a specific health benefit plan or enrollee, the prices charged for specific drugs or classes of drugs, or the amount of any rebates or fees provided for specific drugs or classes of drugs.
(c) Within sixty (60) days of receipt, the commissioner shall publish the report on the Department of Insurance prescription drug price information website developed pursuant to Section 1(1)(b) of this act.
(2) The commissioner may adopt regulations to implement the provisions of this section.
SECTION 6. (1) (a) Not later than February 1, 2022, and annually thereafter, each health insurer shall submit a report to the commissioner. The report shall contain the following information for the immediately preceding calendar year:
(i) The names of the twenty-five (25) most frequently prescribed prescription drugs across all plans;
(ii) Percent increase in annual net spending for prescription drugs across all plans;
(iii) Percent increase in premiums that were attributable to prescription drugs across all plans;
(iv) Percentage of specialty prescription drugs with utilization management requirements across all plans;
(v) Premium reductions that were attributable to specialty drug utilization management.
(b) Within sixty (60) days of receipt, the commissioner shall publish the report on the Department of Insurance prescription drug price information website developed pursuant to Section 1(1)(b) of this act.
(2) Reports submitted by insurers shall not disclose the identity of a specific health benefit plan or the prices charged for specific drugs or classes of drugs.
(3) The commissioner may adopt regulations to implement the provisions of this section.
SECTION 7. This act shall take effect and be in force from and after its passage.
