THE SENATE

S.B. NO.

2376

TWENTY-EIGHTH LEGISLATURE, 2016

S.D. 1

STATE OF HAWAII

H.D. 1

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO PRESCRIPTION DRUG BENEFITS.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  Chapter 431R, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§431R-    Retail community pharmacies; outside of retail pharmacy network; geographic exemption.  (a)  Notwithstanding sections 431R-2 and 431R-3, in any county with an area of two thousand square miles or more, whenever the residence of a beneficiary is ten or more miles away from the nearest retail community pharmacy that is part of the pharmacy benefit manager's retail pharmacy network, the beneficiary may obtain a prescription from any retail community pharmacy located within ten miles of the beneficiary's residence.

     (b)  If a beneficiary utilizes a non-network retail community pharmacy pursuant to subsection (a), no prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager who has entered into a contractual retail pharmacy network agreement with a retail community pharmacy shall:

     (1)  Impose upon the beneficiary a copayment, fee, or other condition not imposed upon beneficiaries electing to utilize a mail order pharmacy or a retail community pharmacy that is part of the pharmacy benefit manager's retail pharmacy network;

     (2)  Subject any prescription dispensed by the non-network retail community pharmacy to the beneficiary to a minimum or maximum quantity limit, length of script, restriction on refills, or requirement to obtain refills not imposed upon a mail order pharmacy or a retail community pharmacy that is part of the pharmacy benefit manager's retail pharmacy network;

     (3)  Require the beneficiary in whole or in part to pay for any prescription dispensed by the non-network retail community pharmacy and seek reimbursement, if the beneficiary is not required to pay for and seek reimbursement in the same manner for a prescription dispensed by a mail order pharmacy or a retail community pharmacy that is part of the pharmacy benefit manager's retail pharmacy network;

     (4)  Subject the beneficiary to any administrative requirement in using a non-network retail community pharmacy that is not imposed upon the use of a mail order pharmacy or a retail community pharmacy that is part of the pharmacy benefit manager's retail pharmacy network; or

     (5)  Impose any other term, condition, or requirement pertaining to the use of the services of a non-network retail community pharmacy that materially and unreasonably interferes with or impairs the right of the beneficiary to obtain prescriptions from a retail community pharmacy of the beneficiary's choice.

     (c)  If a beneficiary utilizes a non-network retail community pharmacy pursuant to subsection (a), the non-network retail community pharmacy shall be reimbursed a $         dispensing fee plus the product cost at the higher rate of reimbursement."

     SECTION 2.  Section 431R-5, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  The insurance commissioner may assess a fine of up to $10,000 for each violation by a pharmacy benefit manager or prescription drug benefit plan provider who is in violation of section 431R-2 [or], 431R-3[.], or 431R-  .  In addition, the insurance commissioner may order the pharmacy benefit manager to take specific affirmative corrective action or make restitution."

     SECTION 3.  The insurance commissioner shall submit an annual report to the legislature no later than twenty days prior to the convening of the 2017, 2018, 2019, 2020, and 2021 regular sessions on the effects of this Act on healthcare costs, including costs to the Hawaii employer-union health benefits trust fund.

     SECTION 4.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 5.  This Act shall take effect on July 1, 2112, and shall be repealed on June 30, 2021; provided that section 431R-5, Hawaii Revised Statutes, shall be reenacted in the form in which it read on the day prior to the effective date of this Act.

Report Title:

Prescription Drugs Benefits; Non-network Pharmacies; Retail Community Pharmacies; Reimbursement

 

Description:

Authorizes in any county with an area of 2,000 square miles or more, a beneficiary of a prescription drug benefit plan whose residence is 10 or more miles away from the nearest retail community pharmacy to obtain a prescription, without penalty, from a non-network retail community pharmacy located within 10 miles of the beneficiary's residence.  Requires reimbursement to a non-network retail community pharmacy.  Requires the Insurance Commissioner to submit annual reports to the Legislature on the effects of this measure on healthcare costs.  (SB2376 HD1)

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.