Bill Text: MS SB2575 | 2026 | Regular Session | Introduced
Bill Title: Pharmacy Benefit Prompt Pay Act; revise various existing and create additional provisions related to.
Sponsorship: Partisan Bill (Republican 1)
Status: (Failed) 2026-02-03 - Died In Committee [SB2575 Detail]
Download: Mississippi-2026-SB2575-Introduced.html
MISSISSIPPI LEGISLATURE
2026 Regular Session
To: Public Health and Welfare
By: Senator(s) Parks
Senate Bill 2575
AN ACT TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE NEW SECTIONS IN THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE AND REVISE TERMS UNDER THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO REVISE THE METHOD OF DETERMINING REIMBURSEMENT TO A PHARMACIST OR PHARMACY BY A PHARMACY BENEFIT MANAGER OR PHARMACY SERVICES ADMINISTRATIVE ORGANIZATION (PSAO) FOR THE DISPENSING OF PRESCRIPTION DRUGS AND OTHER PRODUCTS AND SUPPLIES; TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO PROVIDE A REASONABLE ADMINISTRATIVE APPEAL PROCEDURE TO ALLOW PHARMACIES TO CHALLENGE A REIMBURSEMENT FOR A SPECIFIC DRUG OR DRUGS AS BEING BELOW THE REIMBURSEMENT RATE REQUIRED BY THE PRECEDING PROVISION; TO PROVIDE THAT IF THE APPEAL IS UPHELD, THE PHARMACY BENEFIT MANAGER SHALL MAKE THE CHANGE IN THE PAYMENT TO THE REQUIRED REIMBURSEMENT RATE; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE THE PSAO TO BE LICENSED WITH THE MISSISSIPPI BOARD OF PHARMACY (BOARD); TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER FROM ENGAGING IN SPREAD PRICING; TO AMEND SECTION 73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY, PHARMACY BENEFIT MANAGER OR PHARMACY BENEFIT MANAGER AFFILIATES FROM STEERING; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PSAOS FROM RETALIATING AGAINST A PHARMACY OR PHARMACIST; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE BOARD, FOR THE PURPOSES OF CONDUCTING INVESTIGATIONS, TO CONDUCT EXAMINATIONS OF A PHARMACY BENEFIT MANAGER OR PSAO AND TO ISSUE SUBPOENAS TO OBTAIN DOCUMENTS OR RECORDS THAT IT DEEMS RELEVANT TO THE INVESTIGATION; TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO ANNUALLY REPORT TO THE BOARD CERTAIN INFORMATION ABOUT REBATES AND OTHER PAYMENTS RECEIVED FROM PHARMACEUTICAL MANUFACTURERS; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO CREATE THE MISSISSIPPI SPECIALTY DRUG COMMITTEE AND DIRECT IT TO DEVELOP A LIST OF PRESCRIPTION DRUGS THAT MEET THE CRITERIA FOR SPECIALTY DRUG DESIGNATION TO ASSIST WITH PATIENT ACCESS, TRANSPARENCY AND RESPONSIBLE COST MANAGEMENT; TO CREATE NEW SECTION 73-21-211, MISSISSIPPI CODE OF 1972, TO CREATE THE PHARMACY FAIR COMPETITION ACT; TO CREATE NEW SECTION 73-21-213, MISSISSIPPI CODE OF 1972, TO PROVIDE LEGISLATIVE FINDINGS; TO CREATE NEW SECTION 73-21-215, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER FROM ACQUIRING DIRECT OR INDIRECT INTEREST IN, OR OTHERWISE HOLDING, DIRECTLY OR INDIRECTLY, A PHARMACY PERMIT FOR THE RETAIL SALE OF DRUGS OR MEDICINES IN THIS STATE; TO AUTHORIZE THE BOARD TO ISSUE A LIMITED USE PERMIT UPON A DETERMINATION THAT CERTAIN RARE, ORPHAN OR LIMITED DISTRIBUTION DRUGS ARE OTHERWISE UNAVAILABLE IN THE MARKET; TO CREATE NEW SECTION 73-21-217, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD TO CONDUCT ASSESSMENTS OF EACH ACTIVE RETAIL PHARMACY PERMITS AND TO PROVIDE WRITTEN NOTICE TO PERMIT HOLDERS THAT THE BOARD REASONABLY BELIEVES WILL VIOLATE THIS ACT; TO AMEND SECTION 25-15-301, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE EXECUTIVE DIRECTOR OF THE BOARD, OR HIS OR HER DESIGNEE, SHALL BE A MEMBER OF THE EVALUATION COMMITTEE WHEN THE PROPOSAL FOR EVALUATION IS FOR PHARMACY BENEFITS OR THE MANAGEMENT THEREOF; TO AMEND SECTION 25-15-303, MISSISSIPPI CODE OF 1972, TO ADD THE EXECUTIVE DIRECTOR OF THE BOARD, OR HIS OR HER DESIGNEE; TO THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
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 * * *
Mississippi 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. A 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" means that term as defined 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 that 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 shall 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 * * *" and
"pharmacy" * * * shall have the same
definitions as provided in Section 73-21-73.
(m) "Pharmacy acquisition cost" means the amount that a pharmaceutical wholesaler charges for a pharmaceutical product as listed on the pharmacy's billing invoice.
( * * *n) "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 * * *; and
(ii) The Mississippi Division of Medicaid or its contractors when performing pharmacy benefit manager services for the Division of Medicaid.
( * * *o) "Pharmacy benefit manager affiliate"
means * * * an entity that directly or indirectly * * * owns or
controls, is owned or controlled by, or is under common ownership or control
with a pharmacy benefit manager.
( * * *p) "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.
(q) "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) Adjudicating drug claims or any portion of the transaction.
(ii) Contracting with retail and mail pharmacy networks.
(iii) Establishing payment levels for pharmacies.
(iv) Developing formularies or drug lists of covered therapies.
(v) Providing benefit design consultation.
(vi) Managing cost and utilization trends.
(vii) Contracting for manufacturer rebates.
(viii) Providing fee-based clinical services to improve member care.
(ix) Third-party administration.
(x) Sponsoring or providing cash discount cards as defined in Section 83-9-6.1, and also electronic discount cards.
(r) "Pharmacist services" means products, goods and services, or any combination of products, goods and services, provided as part of the practice of pharmacy.
(s) "Pharmacy services administrative organization" or "PSAO" means any entity that contracts with a pharmacy or pharmacist to assist with third-party payer interactions and that may provide a variety of other administrative services, including, but not limited to, contracting with third-party payers or pharmacy benefit managers on behalf of pharmacies and providing pharmacies or pharmacists with credentialing, billing, audit, general business and analytic support. A covered entity as defined in 42 USC � 256b, including its pharmacy or the transactions related to the 340B drug discount program of any pharmacy contracted with the participating covered entity to dispense drugs purchased through the 340B drug discount program, shall not be considered to be a pharmacy services administrative organization.
( * * *t) "Plan sponsors" means the
employers, insurance companies, unions and health maintenance organizations
that contract, either directly or indirectly, with a pharmacy benefit
manager for delivery of prescription drugs and/or services.
(u) "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.
(v) "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.
(w) "Spread pricing" means any amount charged or claimed by a pharmacy benefit manager or PSAO in excess of the ingredient cost for a dispensed prescription drug plus dispensing fee paid directly or indirectly to any pharmacy, pharmacist, or other provider on behalf of the health benefit plan.
( * * *x) "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.
(y) "Wholesale acquisition cost" means the wholesale acquisition cost of the drug as defined in 42 USC � 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 prescription drugs 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 such 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 subsection (3) of
this section received from all pharmacies in a calendar quarter, * * * such pharmacy benefit manager, PSAO,
agent or other party responsible for reimbursement for prescription drugs and
other products and supplies shall be subject to an administrative
penalty of not more than Twenty-five Thousand Dollars ($25,000.00) to be
assessed by the * * *
board * * *.
(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 a 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 (3) of this section, and in such
case, the provisions of the written agreement shall govern the timely payment
of claims by the pharmacy benefit manager 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 * * *
(5) of this section shall apply.
( * * *d) The * * * board * * * 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 (where the claim is owed to the pharmacy) or the patient (where 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 shall 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 * * * board * * * 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. * * * The board shall promulgate the rules and regulations required by this
paragraph (b) not later than October 1, 2016.
(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 shall 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, that 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. * * *
( * * *41) 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 by subsection (1) of Section 73-21-155.
(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 that 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 shall 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(s) paid to the pharmacist or pharmacy to the greater of either
the pharmacy acquisition cost or the amount required pursuant to subsection (1)
of Section 73-21-155;
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 shall 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 shall be provided a true and correct copy of any 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 same * * * drug, and the amount
reimbursed shall 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 shall not require a pharmacy to collect additional monies following a successful below-cost reimbursement appeal from any 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. This license shall be renewed annually.
(2) When applying for a
license or renewal of a license, each pharmacy benefit manager * * *
shall file * * * with the board * * *
:
(a) A copy of a certified audit report, if the pharmacy benefit manager has been audited by a certified public accountant within the last twenty-four (24) months; or
( * * *b) 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 shall be verified by at least two (2) principal
officers; and
( * * *c) 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 shall be 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 shall 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 shall 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 73-21-161, 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 such patient chooses not to use a
pharmacy benefit manager affiliate pharmacy; * * *
(c) * * *
Advertising, marketing, or * * * promoting an
affiliate * * *
pharmacy or pharmacies over another in-network pharmacy, 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 a pharmacy benefit
manager affiliate includes information regarding eligible nonaffiliate
pharmacies in those communications and the information provided is accurate;
(d) Creating any network or engaging in any practice, including accreditation or credentialing standards, day supply requirements or delivery methods requirements, that exclude an in-network pharmacy or restrict an in-network pharmacy from filling a prescription for a prescription drug; or
(e) Directly or indirectly engaging in any practice that attempts to influence or induce a pharmaceutical manufacturer to limit the distribution of a prescription drug to a small number of pharmacies or certain types of pharmacies, or to restrict distribution of such drug to non-affiliate 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 or pharmacy benefit manager affiliate violate
subsection (2) of this section and the pharmacy provides the disclosures
required in subsection (1) of this section.
* * *
( * * *4) In addition to any other remedy
provided by law, a violation of this section by a pharmacy, 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 shall not apply to facilities licensed to fill prescriptions solely for employees of a plan sponsor or employer.
SECTION 8. The following shall be codified as Section 73-21-162, Mississippi Code of 1972:
73-21-162. (1) Retaliation is prohibited.
(a) A pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO shall not retaliate against a pharmacist or pharmacy based on the pharmacist's or pharmacy's exercise of any right or remedy under this chapter. Retaliation prohibited by this section includes, but is not limited to:
(i) Terminating or refusing to renew a contract with the pharmacist or pharmacy;
(ii) Subjecting the pharmacist or pharmacy to an increased frequency of audits, number of claims audited or amount of monies for claims audited; or
(iii) Failing to promptly pay the pharmacist or pharmacy any money owed by the pharmacy benefit manager to the pharmacist or pharmacy.
(b) For the purposes of this section, a pharmacy benefit manager, pharmacy benefit manager affiliate or PSAO is not considered to have retaliated against a pharmacy if the pharmacy benefit manager:
(i) Takes an action in response to a credible allegation of fraud against the pharmacist or pharmacy; and
(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 shall not penalize or retaliate against a pharmacist, pharmacy or pharmacy employee for exercising any rights under this chapter, initiating any judicial or regulatory actions or discussing or disclosing information pertaining to an agreement with a pharmacy benefit manager or a pharmacy benefit manager affiliate when testifying or otherwise appearing before any governmental agency, legislative member or body or any judicial authority.
SECTION 9. Section 73-21-163, Mississippi Code of 1972, is amended as follows:
73-21-163. (1) Whenever
the board has reason to believe that a pharmacy benefit manager * * *, pharmacy benefit manager affiliate or
PSAO is using, has used, or is about to use any method, act or practice
prohibited in * * * this
act and that proceedings would be in the public interest, it may bring an
action in the name of the board against the pharmacy benefit manager * * *, pharmacy benefit manager affiliate or
PSAO to restrain by temporary or permanent injunction the use of such
method, act or practice. The action shall be brought in the Chancery Court of
the First Judicial District of Hinds County, Mississippi. The court is authorized
to issue temporary or permanent injunctions to restrain and prevent violations
of * * * this act and such injunctions
shall be issued without bond.
(2) The board may impose a
monetary penalty on a pharmacy benefit manager, or a pharmacy benefit
manager affiliate or a 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 shall be 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 may also issue subpoenas to any individual, pharmacy, pharmacy benefit manager, PSAO or any other entity having documents or records that it deems relevant to the investigation.
( * * *4) The board may assess a monetary
penalty for those reasonable costs that are expended by the board in the
investigation and conduct of a proceeding, including the cost of process
service, court reporters, 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 is empowered to request production of documents pertaining to compliance with the provisions of this act, and documents so requested shall be produced within seven (7) days of the request unless extended by the board or its duly authorized staff.
(b) If, after the conclusion of the audit, the pharmacy benefit manager or PSAO was found to be in compliance with all of the requirements of this act, then the board shall pay the costs of the audit. However, the pharmacy benefit manager or PSAO being audited shall pay all costs of such audit if such audit reveals any noncompliance with this act. The cost of the audit examination shall be deposited into the special fund and shall be used by the board, upon appropriation of the Legislature, to support the operations of the board relating to the regulation of pharmacy benefit managers.
(c) The board is authorized to hire independent consultants to conduct audits of a pharmacy benefit manager 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 10. 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 annually report 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) Any pharmacy benefit manager that owns, controls, or is affiliated with a pharmacy shall also 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 11. 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) One (1) 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 the Pharmaceutical Care Management Association;
(e) A representative from the Mississippi Business Alliance;
(f) The executive director of the Mississippi 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; and
(h) The Chairs or their designees from the Senate and House of Representative Drug Policy Committees, who will serve as nonvoting members.
(3) (a) Appointments to the committee shall be made and provided to the executive director of board within thirty (30) days after the effective date of this act. 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 also serve as secretary and shall be responsible for keeping all records for the committee. A majority of the members of the committee shall constitute 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 shall be required. All members shall be notified in writing of all meetings, and those notices shall 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 not later than December 1, 2026. The initial and updated lists of specialty drugs shall be posted on the official website of the state agencies and boards serving on the committee.
(4) The Mississippi 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 12. The following shall be codified as Section 73-21-211, Mississippi Code of 1972:
73-21-211. Sections 73-21-211 through Section 73-21-217 shall be known as the "Pharmacy Fair Competition Act."
SECTION 13. 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 affect 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 the 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 14. The following shall be codified as Section 73-21-215, Mississippi Code of 1972:
73-21-215. (1) As used in this section:
(a) "Board" means the Mississippi Board of Pharmacy.
(b) "Permit" means a permit issued under Section 73-21-105 or Section 73-21-106.
(c) "Pharmacy benefit manager" means that term defined in Section 73-21-153.
(d) "Plan sponsor" means that term as defined in Section 73-21-153.
(2) (a) A pharmacy benefit manager shall 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 the effective date of this act, the Mississippi 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 that 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 subsection (3)(a) of this section 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 that 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 shall 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 shall be 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 shall be made in writing to the board;
(b) The written request shall provide the name and description of the drug, a detailed description of the patient's 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 shall be held before the board within twenty (20) days of receipt of the petition;
(e) The board shall, within thirty (30) days after conclusion of the hearing, reduce its decision to writing and forward an attested true copy thereof to the last-known business address of such pharmacy permit by way of United States first-class, certified mail, postage prepaid and by email to the address provided to the board in its licensing system; and
(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 for the board. The written request shall 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 and a pharmacy that exclusively services the employees and dependents of the pharmacy employer while utilizing the affiliated pharmacy benefit manager in this state.
SECTION 15. 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 violate this act. As used in this subsection (1), "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 shall 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 shall provide its own 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. The written notice that a pharmacy permit holder with written notice from the board under subsection (1) of this section must provide to each patient and each patient's prescribing healthcare provider that has used the pharmacy within the previous twelve (12) months shall be actual notice to the patient via mail or 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, such pharmacies shall 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 16. 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; and
(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 Mississippi 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 of 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 may also be conducted by the Mississippi Board of Pharmacy, under the provisions of Chapter 21, Title 73, Mississippi Code 1972. Any audits conducted by the Mississippi Board of Pharmacy shall be provided to the board and the PEER Committee within fifteen (15) days of final adoption of the results by the 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 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) Any 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 also comply with the provisions of Chapter 21, Title 73, Mississippi Code 1972. If there is a conflict in the application or interpretation of this section and those provisions, then the provision of those statutes shall govern.
SECTION 17. 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 Mississippi 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 18. 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 19. This act shall take effect and be in force from and after July 1, 2026.
