Bill Text: MS SB2861 | 2024 | Regular Session | Introduced
Bill Title: Pharmacy audit integrity act; revise certain definitions related thereto.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2024-03-05 - Died In Committee [SB2861 Detail]
Download: Mississippi-2024-SB2861-Introduced.html
MISSISSIPPI LEGISLATURE
2024 Regular Session
To: Public Health and Welfare
By: Senator(s) Bryan
Senate Bill 2861
AN ACT TO AMEND SECTION 73-21-179, MISSISSIPPI CODE OF 1972, TO REVISE CERTAIN DEFINITIONS UNDER THE PHARMACY AUDIT INTEGRITY ACT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 73-21-179, Mississippi Code of 1972, is amended as follows:
73-21-179. For purposes of Sections 73-21-175 through 73-21-189:
(a) "Entity" means a pharmacy benefit manager, a managed care company, a health plan sponsor, an insurance company, a third-party payor, or any company, group or agent that represents or is engaged by those entities.
(b) "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.
(c) "Individual prescription" means the original prescription for a drug signed by the prescriber, and excludes refills referenced on the prescription.
(d) "Pharmacy
benefit manager" means a business that provides pharmacy benefit management
services or administers the prescription drug/device portion of pharmacy
benefit management plans or health insurance plans on behalf of plan sponsors,
insurance companies, unions and health maintenance organizations. * * *
The term "pharmacy benefit manager" shall not include an insurance company, unless the insurance company is providing services as a pharmacy benefit manager as defined in this section, in which case the insurance company shall be subject to Sections 73-21-151 through 73-21-163 only for those pharmacy benefit manager services.
(e) "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.
(f) Pharmacy benefit management services shall include, but are not limited to, the following services, which may be provided either directly or through outsourcing or contracts with other entities:
(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 formulary or drug list 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.
(x) Sponsoring or providing cash discount cards as defined in Section 83-9-6.1.
(g) "Pharmacist," "pharmacist services" and "pharmacy" or "pharmacies" shall have the same definitions as provided in
Section 73-21-73.
SECTION 2. This act shall take effect and be in force from and after July 1, 2024.
