§ 2904 — Reporting requirements for pharmacy benefit managers

§ 2904. Reporting requirements for pharmacy benefit managers. (a) (1)\n(i) On or before July first of each year, every pharmacy benefit manager\nshall report to the superintendent, in a statement subscribed and\naffirmed as true under penalties of perjury, the information requested\nby the superintendent including, without limitation,\n (A) any pricing discounts, rebates of any kind, inflationary payments,\ncredits, clawbacks, fees, grants, chargebacks, reimbursements, other\nfinancial or other reimbursements, incentives, inducements, refunds or\nother benefits received by the pharmacy benefit manager;\n (B) the terms and conditions of any contract or arrangement, including\nother financial or other reimbursements incentives, inducements or\nrefunds between the pharmacy benefit manager and any other party\nrelating to pharmacy benefit management services provided to a health\nplan including but not limited to, dispensing fees paid to pharmacies;\n (C) the aggregated dollar amount of rebates, fees, price protection\npayments and any other payments the pharmacy benefit manager received\nfrom drug manufacturers through rebate contracts;\n (D) the portions of the amount in clause (C) of this subparagraph\nwhich were:\n 1. passed on to health plans; or\n 2. retained by the pharmacy benefit manager; and\n (E) for each rebate contract in effect during the reporting period:\n 1. the names of the contracting parties;\n 2. the execution date and the term of the contract, including\nextensions;\n 3. the name of the drugs and the associated national drug codes\ncovered by the rebate contract, and for each drug:\n (I) a summary of the contract terms regarding formulary placement,\nformulary exclusion, or prior authorization requirements or step edits,\nof any drugs considered to compete with each drug;\n (II) a summary of all terms requiring or incentivizing volume or\nmarket share for each drug, including base rebate amounts, bundled\nrebates and incremental rebates, stated separately, and price\nconcession, stated separately for each drug; and\n (III) the total number of prescriptions filled and units dispensed for\nwhich a rebate, discount, price concession or other consideration was\nreceived by the pharmacy benefit manager for each drug;\n 4. the rebate percentage and dollar amount retained by the pharmacy\nbenefit manager for every rebate, discount, price concession or other\nconsideration under each rebate contract; and\n 5. the dollar amount of any other compensation paid by a drug\nmanufacturer to a pharmacy benefit manager for services including\ndistribution management services, data or data services, marketing or\npromotional services, research programs, or other ancillary services,\nunder each rebate contract.\n (ii) For the purposes of this subsection, the term "rebate contract"\nmeans any agreement entered into by a pharmacy benefit manager with any\ndrug manufacturer or agent or affiliate of a drug manufacturer that\ndetermines any rebate, discount, administrative or other fee, price\nconcession, or other consideration related to the dispensing of\nprescription drugs for a health plan.\n (2) The superintendent may require the filing of quarterly or other\nstatements, which shall be in such form and shall contain such matters\nas the superintendent shall prescribe.\n (3) The superintendent may address to any pharmacy benefit manager or\nits officers any inquiry in relation to its provision of pharmacy\nbenefit management services or any matter connected therewith. Every\npharmacy benefit manager or person so addressed shall reply in writing\nto such inquiry promptly and truthfully, and such reply shall be, if\nrequired by the superintendent, subscribed by such individual, or by\nsuch officer or officers of the pharmacy benefit manager, as the\nsuperintendent shall designate, and affirmed by them as true under the\npenalties of perjury.\n (b) In the event any pharmacy benefit manager or person does not\nsubmit the report required by paragraph one of subsection (a) of this\nsection or does not provide a good faith response to an inquiry from the\nsuperintendent pursuant to paragraph three of subsection (a) of this\nsection within a time period specified by the superintendent of not less\nthan fifteen business days, the superintendent is authorized to levy a\ncivil penalty, after notice and hearing, against such pharmacy benefit\nmanager or person not to exceed four thousand dollars per day for each\nday beyond the date the report is due or the date specified by the\nsuperintendent for response to the inquiry.\n (c) All information, documents and material disclosed by a pharmacy\nbenefit manager under this section and in the possession or under\ncontrol of the superintendent shall be deemed confidential and not\nsubject to disclosure except where and as the superintendent determines\nthat disclosure is in the public interest. This subsection shall not\napply to information, documents and materials where they are in the\npossession and under the control of a person or entity other than the\nsuperintendent.\n