Missouri SB 978: Enacts provisions relating to payments for prescription drugs

Bill Text

3454S.02C
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SENATE COMMITTEE SUBSTITUTE
FOR
SENATE BILLS NOS. 978 & 1035
AN ACT
To amend chapter 376, RSMo, by adding thereto one new
section relating to payments for prescription drugs,
with penalty provisions.

Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto
one new section, to be known as section 376.414, to read as
follows:
376.414. 1. For purposes of this section, the
following terms mean:
(1) "340B drug", a drug that is:
(a) A covered outpatient drug as defined in Section
340B of the Public Health Service Act, 42 U.S.C. Section
256b, enacted by Section 602 of the Veterans Health Care Act
of 1992, P.L. 102-585; and
(b) Purchased under an agreement entered into under 42
U.S.C. Section 256b;
(2) "Covered entity", a federally-qualified health
center as defined in 42 U.S.C. Section 256b(a)(4)(A);
(3) "Health carrier", the same meaning given to the
term in section 376.1350;
(4) "Pharmacy benefits manager", the same meaning
given to the term in section 376.388;
(5) "Specified pharmacy", a pharmacy licensed under
chapter 338 with which a covered entity has contracted to
dispense 340B drugs on behalf of the covered entity,
regardless of whether the 340B drugs are distributed in
person or through the mail.

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2. A health carrier or pharmacy benefits manager shall
not discriminate against a covered entity or a specified
pharmacy by doing any of the following:
(1) Reimbursing a covered entity or specified pharmacy
for a quantity of a 340B drug in an amount less than such
health carrier or pharmacy benefits manager would pay to any
other similarly situated pharmacy that is not a covered
entity or a specified pharmacy for such quantity of such
drug on the basis that the entity or pharmacy is a covered
entity or specified pharmacy or that the entity or pharmacy
dispenses 340B drugs;
(2) Imposing any terms or conditions on covered
entities or specified pharmacies that differ from such terms
or conditions applied to other similarly situated pharmacies
that are not covered entities or specified pharmacies on the
basis that the entity or pharmacy is a covered entity or
specified pharmacy or that the entity or pharmacy dispenses
340B drugs, including, but not limited to, terms or
conditions with respect to any of the following:
(a) Fees, chargebacks, clawbacks, adjustments, or
other assessments;
(b) Professional dispensing fees;
(c) Restrictions or requirements regarding
participation in standard or preferred pharmacy networks;
(d) Requirements relating to the frequency or scope of
audits or to inventory management systems using generally
accepted accounting principles;
(e) Transferring the benefit of 340B drug-pricing
savings from one entity, including covered entities and
their underserved patients, to another entity, including
without limitation pharmacy benefits managers, private
insurers, health carriers, and managed care organizations;

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(f) Pricing that occurs when offering a lower
reimbursement for a drug purchased under 340B drug pricing
than for the same drug not purchased under 340B drug pricing;
(g) Refusal to cover drugs purchased under 340B drug
pricing;
(h) Refusal to allow 340B drug-pricing pharmacies to
participate in networks;
(i) Charging more than fair market value or seeking
profit sharing in exchange for services involving 340B drug
pricing;
(j) Limiting the number of 340B drug-pricing
pharmacies with which a covered entity may have agreements
to be specified pharmacies;
(k) Requiring a covered entity to report more or
additional data as a condition of having more than one
specified pharmacy; and
(l) Any other restrictions, conditions, practices, or
policies that, as specified by the director of the
department of commerce and insurance, interfere with the
ability of a covered entity to maximize the value of
discounts provided under 42 U.S.C. Section 256b;
(3) Interfering with an individual's choice to receive
a 340B drug from a covered entity or specified pharmacy,
whether in person or via direct delivery, mail, or other
form of shipment;
(4) Requiring a covered entity or specified pharmacy
to identify, either directly or through a third party, 340B
drugs; or
(5) Refusing to contract with a covered entity or
specified pharmacy for reasons other than those that apply
equally to entities or pharmacies that are not covered
entities or specified pharmacies, or on the basis that:

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(a) The entity or pharmacy is a covered entity or a
specified pharmacy; or
(b) The entity or pharmacy is described in any of
subparagraphs (A) to (O) of 42 U.S.C. Section 256b(a)(4).
3. The director of the department of commerce and
insurance shall impose a civil penalty on any pharmacy
benefits manager that violates the requirements of this
section. Such penalty shall not exceed five thousand
dollars per violation per day.
4. The director of the department of commerce and
insurance shall promulgate rules to implement the provisions
of thi