Amendments for HB19-1296
House Journal, April 3
11 HB19-1296 be amended as follows, and as so amended, be referred to
12 the Committee on Finance with favorable recommendation:
13
14 Amend printed bill, page 6, after line 11 insert:
15
16 "(10) "PHARMACY" MEANS AN IN-STATE OR NONRESIDENT
17 PRESCRIPTION DRUG OUTLET, AS DEFINED IN SECTION 12-42.5-102 (35), AN
18 OTHER OUTLET, AS DEFINED IN SECTION 12-42.5-102 (25), A HOSPITAL
19 SATELLITE PHARMACY, AS DEFINED IN SECTION 12-42.5-102 (16), OR
20 OTHER SETTING, INCLUDING A PRACTITIONER'S OFFICE OR CLINIC, WHERE
21 A PRACTITIONER, AS DEFINED IN SECTION 12-42.5-102 (32), DISPENSES
22 PRESCRIPTION DRUGS TO PATIENTS AS AUTHORIZED BY SECTION
23 12-42.5-118 (6).".
24
25 Renumber succeeding subsections accordingly.
26
27 Page 7, strike lines 8 through 10 and substitute "DRUGS, DISPENSED AT A
28 PHARMACY FOR OUTPATIENT USE AND PAID FOR BY A HEALTH INSURER IN
29 THIS STATE DURING THE IMMEDIATELY PRECEDING CALENDAR YEAR, THE".
30
31 Page 7, line 11, strike the first "A".
32
33 Page 12, strike lines 8 through 11 and substitute:
34
35 "(VI) THE PATENT EXPIRATION DATE OF THE PRESCRIPTION DRUG,
36 IF IT IS UNDER PATENT;".
37
38 Page 15, strike line 9 and substitute "reports. (1) STARTING IN 2020,".
39
40 Page 15, line 10, strike "(1)(b) OF THIS SECTION,".
41
42 Page 15, strike lines 22 through 27.
43
44 Page 16, strike lines 1 through 4.
45
46 Page 16, strike lines 5 through 10 and substitute:
47
48 "(2) FOR ALL PRESCRIPTION DRUGS PAID FOR IN THE PRIOR
49 CALENDAR YEAR, THE HEALTH INSURER OR PHARMACY BENEFIT
50 MANAGEMENT FIRM SHALL REPORT:
51 (a) THE AGGREGATE AMOUNT OF ALL REBATES AND DISCOUNTS
52 THAT REDUCE THE COST TO ACQUIRE PRESCRIPTION DRUGS".
53
54 Page 16, line 11, strike "PRESCRIPTION DRUG".
55
1 Page 16, lines 12 and 13, strike "THE PRESCRIPTION DRUG" and substitute
2 "PRESCRIPTION DRUGS".
3
4 Page 16, strike lines 14 through 16 and substitute "YEAR;
5 (b) THE AGGREGATE AMOUNT OF ALL REBATES AND DISCOUNTS
6 THAT REDUCE THE COST TO ACQUIRE ALL PRESCRIPTION DRUGS".
7
8 Page 16, line 17, strike "PRESCRIPTION DRUG".
9
10 Page 16, line 20, strike "TOTAL" and substitute "AGGREGATE".
11
12 Page 16, line 22, strike "THE PRESCRIPTION DRUG;" and substitute "ALL
13 PRESCRIPTION DRUGS; AND".
14
15 Page 16, strike lines 23 through 27.
16
17 Page 17, strike lines 1 through 9.
18
19 Reletter succeeding paragraphs accordingly.
20
21 Page 17, line 10, strike "TOTAL" and substitute "AGGREGATE".
22
23 Page 17, lines 11 and 12, strike "THE PRESCRIPTION DRUG," and substitute
24 "PRESCRIPTION DRUGS,".
25
26 Page 17, strike lines 16 through 18 and substitute:
27
28 "(e) AN EXPLANATION OF ALL OTHER SERVICES OFFERED BY THE
29 HEALTH INSURER OR PHARMACY BENEFIT MANAGEMENT FIRM, EXCLUDING
30 PROPRIETARY AND CLIENT-SPECIFIC INFORMATION.".
31
32 Page 18, line 13, after "VALUE" insert "THAT EXCEEDS ONE THOUSAND
33 DOLLARS IN VALUE".
34
35 Page 18, strike line 16 and substitute "11 OR A TRADE ASSOCIATION
36 REPRESENTING ANY OF THOSE INDUSTRIES.".
37
38 Page 19, line 6, after "VALUE" insert "THAT EXCEEDS ONE THOUSAND
39 DOLLARS IN VALUE".
40
41 Page 19, after line 9 insert:
42
43 "(4) A NONPROFIT ORGANIZATION SUBJECT TO THE REPORTING
44 REQUIREMENTS OF THIS SECTION THAT FAILS TO COMPLY WITH THE
45 REQUIREMENTS IS SUBJECT TO A FINE OF UP TO ONE THOUSAND DOLLARS.".
46
47 Page 19, line 26, strike "INFORMATION REPORTED BY" and substitute
48 "COMBINED AGGREGATE INFORMATION REPORTED BY ALL HEALTH
49 INSURERS AND".
50
51 Page 22, after line 5 insert:
52
53 "(b) AT LEAST THIRTY DAYS BEFORE THE COMMISSIONER
54 PUBLISHES AND SUBMITS THE REPORT PURSUANT TO SUBSECTIONS (2)(c)
55 AND (2)(d) OF THIS SECTION , THE COMMISSIONER SHALL PROVIDE HEALTH
1 INSURERS, MANUFACTURERS, AND PHARMACY BENEFIT MANAGEMENT
2 FIRMS THAT REPORTED DATA TO THE COMMISSIONER PURSUANT TO THIS
3 PART 11 AN EXPLANATION AND DESCRIPTION OF THE INFORMATION THAT
4 WILL BE RELEASED IN THE REPORT AND AN OPPORTUNITY TO OBJECT TO
5 THE RELEASE OF SPECIFIED INFORMATION ON THE GROUNDS THAT THE
6 INFORMATION IS PROPRIETARY. A HEALTH INSURER, MANUFACTURER, OR
7 PHARMACY BENEFIT MANAGEMENT FIRM OBJECTING TO THE RELEASE OF
8 INFORMATION MUST SUBMIT ITS OBJECTION AND INFORMATION
9 DEMONSTRATING THAT THE SPECIFIED INFORMATION IS PROPRIETARY NO
10 LATER THAN FIFTEEN DAYS AFTER RECEIPT OF THE EXPLANATION AND
11 DESCRIPTION FROM THE COMMISSIONER. THE COMMISSIONER SHALL MAKE
12 A DETERMINATION AND NOTIFY THE OBJECTING PARTY OF THE
13 DETERMINATION WITHIN FIFTEEN DAYS AFTER RECEIPT OF THE OBJECTION
14 FROM THE HEALTH INSURER, MANUFACTURER, OR PHARMACY BENEFIT
15 MANAGEMENT FIRM AND, IF THE COMMISSIONER FINDS IN FAVOR OF THE
16 OBJECTING PARTY, SHALL REMOVE THE PROPRIETARY INFORMATION FROM
17 THE REPORT BEFORE PUBLISHING AND SUBMITTING IT PURSUANT TO
18 SUBSECTIONS (2)(c) AND (2)(d) OF THIS SECTION. THE DETERMINATION OF
19 THE COMMISSIONER IS FINAL AND IS NOT SUBJECT TO REVIEW.".
20
21 Reletter succeeding paragraphs accordingly.
22
23 Page 26, strike lines 18 and 19 and substitute:
24
25 "(c) "PHARMACY" MEANS AN IN-STATE OR NONRESIDENT
26 PRESCRIPTION DRUG OUTLET, AS DEFINED IN SECTION 12-42.5-102 (35), AN
27 OTHER OUTLET, AS DEFINED IN SECTION 12-42.5-102 (25), A HOSPITAL
28 SATELLITE PHARMACY, AS DEFINED IN SECTION 12-42.5-102 (16), OR
29 OTHER SETTING, INCLUDING A PRACTITIONER'S OFFICE OR CLINIC, WHERE
30 A PRACTITIONER, AS DEFINED IN SECTION 12-42.5-102 (32), DISPENSES
31 PRESCRIPTION DRUGS TO PATIENTS AS AUTHORIZED BY SECTION
32 12-42.5-118 (6).".
33
34 After "THE" insert "AGGREGATE" on: Page 17, lines 13 and 14.
35
36
House Journal, April 12
19 HB19-1296 be amended as follows, and as so amended, be referred to
20 the Committee on Appropriations with favorable
21 recommendation:
22
23 Amend printed bill, page 8, line 5, strike "REBATES," and substitute
24 "REBATES AND".
25
26 Page 8, line 6, strike "OR OTHER SOURCES OF REVENUE" and substitute
27 "OTHER THAN REBATES USED TO REDUCE COST SHARING FOR PRESCRIPTION
28 DRUGS IN ACCORDANCE WITH SECTION 10-16-148,".
29
30 Page 26, lines 22 and 23, strike "Cost sharing in prescription drugs -
31 limits - definitions - confidentiality of rebate information" and
32 substitute "Cost sharing for prescription drugs - required rebate
33 reductions - definitions".
34
35 Page 27, strike lines 7 through 27.
36
37 Page 28, strike lines 1 through 4 and substitute:
38
39 "(d) "REBATE" MEANS A PRICE CONCESSION GIVEN BY A
40 MANUFACTURER DIRECTLY TO A CARRIER OR PHARMACY BENEFIT
41 MANAGEMENT FIRM THAT REDUCES THE CARRIER'S PRESCRIPTION DRUG
42 COSTS FOR THE BENEFIT YEAR.
43 (2) FOR EACH OF ITS HEALTH COVERAGE PLANS ISSUED OR
44 RENEWED ON OR AFTER JANUARY 1, 2021, A CARRIER SHALL REDUCE THE
45 AMOUNT OF COST SHARING THAT IT WOULD OTHERWISE CHARGE A
46 COVERED PERSON FOR A PRESCRIPTION DRUG BY AN AMOUNT EQUAL TO
47 ONE HUNDRED PERCENT OF THE ESTIMATED REBATE PER PRESCRIPTION
48 THAT THE CARRIER RECEIVED FOR THE PRESCRIPTION DRUG, CALCULATED
49 BASED ON THE REBATES THE CARRIER RECEIVED FOR THAT PRESCRIPTION
50 DRUG IN THE PREVIOUS QUARTER; EXCEPT THAT THE REDUCTION AMOUNT
51 SHALL NOT EXCEED AN AMOUNT EQUAL TO THE COVERED PERSON'S
52 COST-SHARING AMOUNT THAT WOULD OTHERWISE BE CHARGED FOR THE
53 DISPENSED PRESCRIPTION DRUG. NEITHER THE COVERED PERSON NOR THE
54 CARRIER IS RESPONSIBLE FOR ANY DIFFERENCE BETWEEN THE ESTIMATED
55 REBATE AMOUNT AND THE ACTUAL REBATE THE CARRIER RECEIVES.".
1 Page 28, line 9, strike "SECTION." and substitute "SECTION, WHICH RULES
2 MUST ENSURE THAT REBATES ARE APPLIED IN A MANNER TO PROVIDE A
3 PRICE REDUCTION FOR COVERED PERSONS WHO HAVE NOT REACHED THEIR
4 ANNUAL COST-SHARING LIMIT AND TO LIMIT THE EFFECT ON PREMIUMS.".
5
6