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Legislative Year: 2021 Change
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Bill Detail: HB21-1237

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Title Competitive Pharmacy Benefits Manager Marketplace
Status Governor Signed (06/07/2021)
Bill Subjects
  • State Government
House Sponsors S. Lontine (D)
J. Rich (R)
Senate Sponsors D. Moreno (D)
B. Kirkmeyer (R)
House Committee Health and Insurance
Senate Committee Health and Human Services
Date Introduced 03/22/2021
Summary

The department of personnel (department) is required to contract
for the services of a pharmacy benefit manager (PBM) for group benefit
plans provided pursuant to the State Employees Group Benefits Act
(state employee group benefits plans) and to procure a technology
platform with the required capabilities for conducting a PBM reverse
auction and the related services of a technology platform operator.

The department is required to repurpose the technology platform
used to conduct the reverse auction over the duration of the PBM services
contract to perform reviews of all invoiced PBM prescription drug claims,
and to identify all deviations from the specific terms of the PBM services
contract. The department is required to reconcile the electronically
adjudicated pharmacy claims with PBM invoices to ensure that state
payments do not exceed the terms specified in any PBM services contract.
Each PBM reverse auction is required to be completed and the
PBM services contract awarded to the winning PBM within a specified
timeline.
The department may perform a market check for providing PBM
services during the term of the current PBM services contract to ensure
continuing competitiveness of incumbent prescription drug pricing over
the life of a PBM services contract.
To ensure that the department does not incur additional
expenditures associated with the requirements of the bill, the department
is required to implement a no-pay option that obligates the winning PBM
to pay the cost of the technology platform and related technology
platform operator services by assessing a per-prescription fee and
requiring the PBM to pay these fees to the technology operator over the
duration of the PBM services contract.
The bill allows other health plans to use the processes and
procedures established in the bill individually, collectively, or as a joint
purchasing group with the state employee group benefits plans.
After completion of the first state employees group benefits plans
PBM reverse auction, self-funded private sector employer or
multi-employer health plans have the option to participate in a joint
purchasing pool with state employees for conduct of subsequent PBM
reverse auctions.
The state employees group benefits plans and any self-funded
public or private sector health plans that opt to participate with the state
employees group benefits plans in a joint PBM reverse auction
purchasing pool shall retain full autonomy over determination of their
respective prescription drug formularies and pharmacy benefit designs
and shall not be required to adopt a common prescription drug formulary
or common prescription pharmacy benefit design.
Any PBM providing services to the department or a self-funded
public or private sector employee health plan is required to provide the
department and the plan access to complete pharmacy claims data
necessary to conduct the reverse auction and carry out their administrative
and management duties.

Committee Reports
with Amendments
Full Text
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Fiscal Notes Fiscal Notes (05/11/2021) (most recent)  
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