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THE SENATE |
S.B. NO. |
1509 |
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THIRTY-THIRD LEGISLATURE, 2025 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to prescription drugs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
"Part . Health care INSURER share the savings act
§431:10A- Short title. This part shall be known and may be cited as the Health Care Insurer Share the Savings Act.
§431:10A- Definitions. As used in this part:
"Commissioner" means the insurance commissioner of the State.
"Defined cost sharing" means a deductible payment or coinsurance amount imposed on an enrollee for a covered prescription drug under the enrollee's health benefit plan.
"Enrollee" means an individual entitled to coverage of health care services from a health care insurer.
"Health benefit plan" means any individual, blanket, or group plan, policy, or contract for health care services issued or delivered by a health care insurer in the State. "Health benefit plan" does not include:
(1) Accident-only plans;
(2) Specified disease plans;
(3) Disability income plans;
(4) Plans that provide only for indemnity for hospital confinement;
(5) Long-term-care-only plans that do not include pharmacy benefits;
(6) Other limited-benefit health insurance policies or plans;
(7) Health benefit plans provided under chapter 386; or
(8) Any state or local governmental employee plan.
"Health care insurer" means a:
(1) Health insurance issuer that:
(A) Is subject to state law regulating insurance; and
(B) Offers health insurance coverage as defined in title 42 United States Code section 300gg-91, as it existed on January 1, 2025;
(2) Health maintenance organization; or
(3) Hospital and medical service corporation.
"Health care insurer" does not include an entity that provides only dental benefits or eye and vision care benefits.
"Price protection rebate" means a negotiated price concession that accrues directly or indirectly to a health care insurer, or other party on behalf of the health care insurer, if there is an increase in the wholesale acquisition cost of a prescription drug above a specified threshold.
"Rebate" means:
(1) A negotiated price concession, including without limitation base price concessions, whether described as a rebate or not, reasonable estimates of any price protection rebates, and performance-based price concessions that may accrue, directly or indirectly, to the health care insurer during the coverage year from a manufacturer or other party in connection with the dispensing or administration of a prescription drug; and
(2) Any reasonable estimate of a negotiated price concession, fee, and other administrative cost that is passed through, or is reasonably anticipated to be passed through, to the health care insurer and serves to reduce the health care insurer's liabilities for a prescription drug.
§431:10A- Health care insurer requirements; cost sharing; confidentiality; rebate. (a) Any health care insurer that receives a rebate in connection with the dispensing or administration of a prescription drug shall share the benefit of the rebate with enrollees in the State.
(b) An enrollee's defined cost sharing for a prescription drug shall be calculated at the point-of-sale based on a price that is reduced by an amount equal to at least one hundred per cent of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.
(c) This section shall not prohibit a health care insurer from decreasing an enrollee's defined cost sharing by an amount greater than that required under subsection (b).
(d) In implementing the requirements of this section, the State shall only regulate a health care insurer to the extent permissible under applicable law.
(e) Nothing in this section shall be construed to require a health care insurer or its agents to publish or otherwise reveal information regarding the actual amount of rebates a health care insurer receives on a product or therapeutic class of products, manufacturer, or pharmacy‑specific basis; provided that the information is:
(1) Protected as a trade secret;
(2) Considered proprietary and confidential under section 431:3-304, 431:3D-108, or 431:3G-106;
(3) Not subject to disclosure pursuant to chapter 92F; or
(4) Not to be disclosed, directly or indirectly, in a manner that would:
(A) Allow for the identification of an individual product, therapeutic class of products, or manufacturer; or
(B) Have the potential to compromise the financial, competitive, or proprietary nature of the information.
A health care insurer shall impose the confidentiality protections of this subsection on any vendor or downstream third party that performs health care or administrative services on behalf of the health care insurer that may receive or have access to rebate information."
SECTION 2. Chapter 431S, Hawaii Revised Statutes, is amended by designating sections 431S-1 to 431S-6 as part I, entitled "General Provisions".
SECTION 3. Chapter 431S, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:
"Part . Pharmacy benefit manager share the savings
act
§431S- Short title. This part shall be known and may be cited as the Pharmacy Benefits Manager Share the Savings Act.
§431S- Definitions. As used in this part:
"Defined cost sharing" means a deductible payment or coinsurance amount imposed on an enrollee for a covered prescription drug under the enrollee's health benefit plan.
"Enrollee" means an individual entitled to coverage of health care services from a health care insurer.
"Health benefit plan" means any individual, blanket, or group plan, policy, or contract for health care services issued or delivered by a health care insurer in the State. "Health benefit plan" does not include:
(1) Accident-only plans;
(2) Specified disease plans;
(3) Disability income plans;
(4) Plans that provide only for indemnity for hospital confinement;
(5) Long-term-care-only plans that do not include pharmacy benefits;
(6) Other limited-benefit health insurance policies or plans;
(7) Health benefit plans provided under chapter 386; or
(8) Any state or local governmental employee plan.
"Health care insurer" means an insurance company that is subject to state law regulating insurance including without limitation a health maintenance organization or a hospital and medica service corporation.
"Price protection rebate" means a negotiated price concession that accrues directly or indirectly to a health care insurer, or other party on behalf of the health care insurer, if there is an increase in the wholesale acquisition cost of a prescription drug above a specified threshold.
"Rebate" means:
(1) A negotiated price concession, including without limitation base price concessions, whether described as a rebate or not, reasonable estimates of any price protection rebates, and performance-based price concessions that may accrue, directly or indirectly, to the health care insurer during the coverage year from a manufacturer or other party in connection with the dispensing or administration of a prescription drug; and
(2) Any reasonable estimate of a negotiated price concession, fee, and other administrative cost that is passed through, or is reasonably anticipated to be passed through, to the health care insurer and serves to reduce the health care insurer's liabilities for a prescription drug.
§431S- Pharmacy benefit manager requirements; cost sharing; confidentiality; rebate. (a) All pharmacy benefit managers shall share the benefit of rebates with enrollees in the State.
(b) An enrollee's defined cost sharing for a prescription drug shall be calculated at the point-of-sale based on a price that is reduced by an amount equal to at least one hundred per cent of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.
(c) This section shall not prohibit a pharmacy benefit manager from decreasing an enrollee's defined cost sharing by an amount greater than that required under subsection (b).
(d) A pharmacy benefit manager shall submit a certification to the commissioner by January 1 of each calendar year certifying that the pharmacy benefit manager has complied with the requirements of this section during the previous calendar year; provided that the certification shall be signed by the chief executive officer or chief financial officer of the pharmacy benefit manager; provided further that the form of the certification shall:
(1) Be in a format approved or established by the commissioner; and
(2) Include the pharmacy benefit manager's best estimate of the aggregate amount of rebates used to reduce enrollee-defined cost sharing for prescription drugs in the previous calendar year based on information known to the pharmacy benefit manager as of the date of the certification.
(e) Nothing in this section shall be construed to require a pharmacy benefit manager or its agents to publish or otherwise reveal information regarding the actual amount of rebates a pharmacy benefit manager receives on a product or therapeutic class of products, manufacturer, or pharmacy-specific basis; provided that the information is:
(1) Protected as a trade secret;
(2) Considered proprietary and confidential under section 431:3-304, 431:3D-108, or 431:3G-106;
(3) Not subject to disclosure pursuant to chapter 92F; or
(4) Not to be disclosed, directly or indirectly, in a manner that would:
(A) Allow for the identification of an individual product, therapeutic class of products, or manufacturer; or
(B) Have the potential to compromise the financial, competitive, or proprietary nature of the information.
A pharmacy benefit manager shall impose the confidentiality protections of this subsection on any vendor or downstream third party that performs health care or administrative services on behalf of the pharmacy benefit manager that may receive or have access to rebate information."
SECTION 4. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
SECTION 5. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Prescription Drugs; Health Care Insurer Share the Savings Act; Pharmacy Benefit Manager Share the Savings Act; Rebate; Annual Certification
Description:
Requires health insurers and pharmacy benefit managers to reduce an enrollee's defined cost sharing for a prescription drug by a price amount equal to at least 100 per cent of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug. Requires a pharmacy benefit manager to submit a certification to the Insurance Commissioner by January 1 of each calendar year certifying compliance with the cost sharing requirements. Establishes protections for the publishing of certain confidential or proprietary information by health insurers or pharmacy benefit managers.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.