Carriers - pharmacy benefit management firms - contracts with pharmacies and pharmacists - prohibitions against disallowing cost-sharing measures. The act prohibits a carrier that has a contract with a pharmacy or pharmacist, or a pharmacy benefit management firm acting on behalf of a carrier, from:
- Prohibiting a pharmacy or pharmacist from, or penalizing a pharmacy or pharmacist for, providing a covered person information on the amount of the covered person's cost share for the covered person's prescription drug and the clinical efficacy of any more affordable alternative drugs that are therapeutically equivalent; or
- Requiring a pharmacy to charge or collect a copayment from a covered person that exceeds the total submitted charges by the network pharmacy.
The act requires the commissioner of insurance to act when the commissioner determines that a carrier or pharmacy benefit management firm has engaged in the prohibited conduct.
(Note: This summary applies to this bill as enacted.)