SB 125 (BR 1113) - J. Denton, J. Bowen, D. Harper Angel, J. Higdon, P. Hornback, D. Parrett, J. Pendleton, J. Rhoads, J. Schickel, J. Turner
AN ACT relating to pharmacy health benefit management.
Create a new section of Subtitle 17A of KRS Chapter 304 to define the terms "contracted pharmacy," "generic exclusivity period," "maximum allowable cost," "multiple source drug," "nationally available," "obsolete," "pharmacy benefit manager," and "temporarily unavailable"; prohibit a pharmacy benefit manager from using a maximum allowable cost as a basis for reimbursement to a pharmacy for a multiple source drug prior to the expiration of the generic exclusivity period; permit a pharmacy benefit manager to use the maximum allowable cost for reimbursement if there are three or more A-rated therapeutically equivalent multiple source drugs available at a significant cost difference; require the maximum allowable cost to be determined using drug price data from multiple data sources; require a benefit manager using maximum allowable cost for reimbursement to identify the drug price data source and methodology and notify the pharmacy regarding maximum allowable cost implementation, discontinuation, and adjustments; establish requirements for an appeals process; require a benefit manager to provide a contractual commitment to a contracted pharmacy to deliver a specific average reimbursement rate for multiple source drugs; establish requirements for calculation of the average reimbursement rate for multiple source drugs; create a new section of KRS Chapter 205 to require a managed care organization that provides Medicaid benefits to make a maximum allowable cost list available to a contracted pharmacy in a readily usable format.
Jan 30-introduced in Senate
Feb 1-to Health & Welfare (S)
Feb 8-reported favorably, 1st reading, to Calendar
Feb 9-2nd reading, to Rules
Feb 22-recommitted to Appropriations & Revenue (S)