No. SB 1638
Filed under Insurance.
Prohibitions Against Discriminatory Practices Relating to 340B Entities and 340B Drugs; Prohibiting drug manufacturers from engaging in certain acts relating to the acquisition of 340B drugs by and the delivery of such drugs to specified pharmacies; prohibiting health insurance issuers, pharmacy benefit managers, and other third-party payors, and agents thereof, from engaging in certain discriminatory acts relating to reimbursement to 340B entities for 340B drugs; prohibiting individual health insurers, group, blanket, and franchise health insurers, and health maintenance organizations, respectively, and pharmacy benefit managers on behalf of such insurers and health maintenance organizations, from engaging in certain discriminatory acts relating to reimbursement to 340B entities for 340B drugs, etc.
Plain English Summary
AI-GENERATEDDrug manufacturers can no longer refuse to sell or deliver 340B drugs to a pharmacy under contract with a 340B entity, or block that pharmacy from contracting with the entity.
Health insurers, HMOs, and pharmacy benefit managers may not pay 340B entities less than they pay other pharmacies for the same drug, or charge them extra fees other pharmacies do not pay.
Payors cannot exclude 340B pharmacies from their networks, refuse to contract with them, or add extra requirements that discourage patients from choosing a 340B pharmacy.
Violating any of these rules is automatically treated as a deceptive and unfair trade practice, exposing the violator to state investigations and penalties under existing consumer-protection law.
AIA manufacturer may not deny, restrict, or interfere with a contract pharmacy's acquisition or delivery of 340B drugs, unless the U.S. Department of Health and Human Services itself prohibits that pharmacy from receiving them.
AIHealth insurers, HMOs, pharmacy benefit managers, and other third-party payors may not reimburse a 340B entity for a drug at a lower rate than they pay non-340B pharmacies for the identical drug.
AIA payor may not base any action or contract term on an entity's 340B status in a way that adds a restriction or charge on a patient who chooses to get drugs from a 340B entity or its contracted pharmacy.
AISeparately from the delivery rule, a manufacturer may not interfere with a pharmacy's right to sign a contract with a 340B covered entity to dispense 340B drugs on the entity's behalf in the first place.
AIPayors may not impose fees, dispensing rates, network restrictions, or audit requirements on a 340B entity that differ from what they impose on non-340B pharmacies for the same work.
AIA health insurance issuer, pharmacy benefit manager, or other third-party payor may not exclude a 340B entity from its network or refuse to contract with it because it dispenses 340B drugs.
AIAny prohibited act by a manufacturer or payor is automatically a deceptive and unfair trade practice, subjecting the violator to the investigations, remedies, and penalties available under that existing consumer-protection law.