Enacts new GS 58-56A-3 requiring that in order for a prescription drug to be placed on the maximum allowable cost price list, that the drug be available for purchase by pharmacies in the state from national or regional wholesalers, must not be obsolete, and either (1) be listed as “A” or “B” rated in the most recent version of the US Food and Drug Administration’s Approved Drug Products with Therapeutic Equivalence Evaluations or (2) have an “NR” or “NA” rating, or similar rating, by a nationally recognized reference. Requires a pharmacy benefits manager to adjust or remove a maximum allowable cost price for a prescription drug as necessary for a cost of a prescription drug to remain consistent with changes in the national marketplace. Requires a review of the maximum allowable cost prices for removal or modification to be completed by the pharmacy benefits manager at least once every seven business days. Requires a pharmacy benefits manager to provide a way for the contracted pharmacies to promptly review current prices within one business day of the change or removal. Imposes a fee of no less than $100 and no more than $1,000 per day per drug on a pharmacy benefits manager that does not perform any review, adjustment, or removal in a timely manner.
Amends GS 58-63-15 to add the following to those that are considered unfair methods of competition and unfair and deceptive acts or practices in insurance: (1) any violation of the prohibition against waiver, discount, rebate, or distortion of a copayment or coinsurance of any insurer, policy, or plan, or any violation of the prohibition against waiver of the collection of copayments owed by recipients of Medicaid and NC Health Choice and (2) a failure by a pharmacy benefits manager to perform in a timely manner any review, adjustment, or removal.
Effective October 1, 2015.
PENALTIES FOR NONCOMPLIANCE.
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View NCGA Bill Details | 2015-2016 Session |
AN ACT TO REQUIRE PHARMACY BENEFITS MANAGERS TO TIMELY ADJUST THE COST PRICE AND TO MAKE CERTAIN ACTIONS.Intro. by Tillman.
Status: Re-ref to Health Care. If fav, re-ref to Insurance (Senate Action) (Mar 30 2015)
Bill History:
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Wed, 25 Mar 2015 Senate: Filed
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Thu, 26 Mar 2015 Senate: Passed 1st Reading
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Thu, 26 Mar 2015 Senate: Ref To Com On Rules and Operations of the Senate
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Mon, 30 Mar 2015 Senate: Withdrawn From Com
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Mon, 30 Mar 2015 Senate: Re-ref to Health Care. If fav, re-ref to Insurance
S 451
Bill Summaries:
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Bill S 451 (2015-2016)Summary date: Mar 25 2015 - View Summary
View: All Summaries for Bill