§1870. Pharmacy benefit manager transparency report; examination by commissioner
A. Each pharmacy benefit manager licensed by the commissioner shall submit an
annual transparency report as a condition of maintaining licensure.
B.
(1)On March first of each year, each licensed pharmacy benefit manager shall
submit a transparency report containing data from the prior calendar year to the department.
The transparency report shall contain the following information for each of the pharmacy
benefit manager's contractual or other relationships with a health benefit plan or health
insurance issuer:
(a)The total amount of all rebates that the pharmacy benefit manager received from
pharmaceutical manufacturers.
(b)The total amount of all administrative fees that the pharmacy benefit manager
receive
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§1870. Pharmacy benefit manager transparency report; examination by commissioner
A. Each pharmacy benefit manager licensed by the commissioner shall submit an
annual transparency report as a condition of maintaining licensure.
B.(1) On March first of each year, each licensed pharmacy benefit manager shall
submit a transparency report containing data from the prior calendar year to the department.
The transparency report shall contain the following information for each of the pharmacy
benefit manager's contractual or other relationships with a health benefit plan or health
insurance issuer:
(a) The total amount of all rebates that the pharmacy benefit manager received from
pharmaceutical manufacturers.
(b) The total amount of all administrative fees that the pharmacy benefit manager
received.
(c) The total amount of all negotiated price concessions such as base price
concessions, reasonable estimates of any price protection rebates other than manufacturer
rebates, and performance-based price concessions.
(d) The total amount of all rebates passed to enrollees at the point of sale of a
prescription drug.
(e) The total amount of all reimbursement paid to network pharmacies in this state,
specifically identified by local pharmacy and non-local pharmacy.
(f) The total amount of all specialty drug rebates that the pharmacy benefit manager
received.
(g) The total number of other services provided by the pharmacy benefit manager or
its affiliates or subsidiaries in addition to prescription drugs. The total amount reported shall
include identification of the service, the number of services provided, by whom they were
provided, and the dollar amount relative to the provision of the services.
(h) The complete corporate vertical integration structure of all components related
to the pharmacy benefit manager including the insurer, pharmacy benefit manager, group
purchasing organization, manufacturer, wholesale distributor, special or mail order
pharmacy, retail or long-term care pharmacy, and provider.
(2) The transparency report shall be made available in a form that does not disclose
the identity of a specific health benefit plan, the prices charged for specific drugs or classes
of drugs, or the amount of any rebates provided for specific drugs or classes of drugs.
(3) Within sixty days of receipt, the Department of Insurance shall publish the
transparency report on the department's website in a location designated for pharmacy benefit
manager information.
(4) The pharmacy benefit manager and the Department of Insurance shall not publish
or disclose any information that would reveal the identity of a specific health benefit plan,
the prices charged for a specific drug or class of drugs, or the amount of any rebates provided
for a specific drug or class of drugs. Any such information shall be protected from disclosure
as confidential and proprietary information and shall not be regarded as a public record
pursuant to the Public Records Law.
(5) A pharmaceutical drug manufacturer shall provide notice not later than thirty
days after increasing the wholesale acquisition drug cost of a brand name drug by more than
fifteen percent per wholesale acquisition cost unit during any twelve-month period, or
generic or biosimilar drug with a significant price increase, as defined by the commissioner,
in any twelve-month period, or introducing a new drug for distribution in this state when the
wholesale acquisition cost is greater than the amount that causes the drug to be considered
a specialty drug under the Medicare Part D program. The manufacturer shall also report to
the commissioner specific information about the drug subject to a price increase and an
explanation of the increase, including whether it was in response to any rebate or formulary
requirement.
C. The information required pursuant to this Section shall be submitted in a format
determined by the commissioner.
D.(1) The commissioner may examine the books or records of a pharmacy benefit
manager to determine the accuracy of the transparency report. The commissioner shall have
access to any information he considers necessary to determine the accuracy of the
transparency report including but not limited to individual amounts paid by a health
insurance issuer to the pharmacy benefit manager for drugs, devices, or services provided by
a pharmacist or pharmacy, and the individual amount a pharmacy benefit manager paid to
a pharmacist or pharmacy for the same drug, device, or service.
(2) This Section does not limit the power of the commissioner to examine or audit
the books or records of a pharmacy benefit manager.