AN ACT TO AMEND SECTION 73-21-151, MISSISSIPPI CODE OF 1972, TO REFERENCE NEW SECTIONS IN THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-153, MISSISSIPPI CODE OF 1972, TO DEFINE AND REVISE TERMS UNDER THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO REVISE THE METHOD OF DETERMINING REIMBURSEMENT TO A PHARMACIST OR PHARMACY BY A PHARMACY BENEFIT MANAGER OR PHARMACY SERVICES ADMINISTRATIVE ORGANIZATION (PSAO) FOR THE DISPENSING OF PRESCRIPTION DRUGS AND OTHER PRODUCTS AND SUPPLIES; TO AMEND SECTION 73-21-156, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO PROVIDE A REASONABLE ADMINISTRATIVE APPEAL PROCEDURE TO ALLOW PHARMACIES TO CHALLENGE A REIMBURSEMENT FOR A SPECIFIC DRUG OR DRUGS AS BEING BELOW THE REIMBURSEMENT RATE REQUIRED BY THE PRECEDING PROVISION; TO PROVIDE THAT IF THE APPEAL IS UPHELD, THE PHARMACY BENEFIT MANAGER SHALL MAKE THE CHANGE IN THE PAYMENT TO THE REQUIRED REIMBURSEMENT RATE; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE THE PSAO TO BE LICENSED WITH THE MISSISSIPPI BOARD OF PHARMACY (BOARD); TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER FROM ENGAGING IN SPREAD PRICING; TO AMEND SECTION 73-21-161, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY, PHARMACY BENEFIT MANAGER OR PHARMACY BENEFIT MANAGER AFFILIATES FROM STEERING; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PSAOS FROM RETALIATING AGAINST A PHARMACY OR PHARMACIST; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE BOARD, FOR THE PURPOSES OF CONDUCTING INVESTIGATIONS, TO CONDUCT EXAMINATIONS OF A PHARMACY BENEFIT MANAGER OR PSAO AND TO ISSUE SUBPOENAS TO OBTAIN DOCUMENTS OR RECORDS THAT IT DEEMS RELEVANT TO THE INVESTIGATION; TO CREATE NEW SECTION 73-21-165, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS TO ANNUALLY REPORT TO THE BOARD CERTAIN INFORMATION ABOUT REBATES AND OTHER PAYMENTS RECEIVED FROM PHARMACEUTICAL MANUFACTURERS; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO CREATE THE MISSISSIPPI SPECIALTY DRUG COMMITTEE AND DIRECT IT TO DEVELOP A LIST OF PRESCRIPTION DRUGS THAT MEET THE CRITERIA FOR SPECIALTY DRUG DESIGNATION TO ASSIST WITH PATIENT ACCESS, TRANSPARENCY AND RESPONSIBLE COST MANAGEMENT; TO CREATE NEW SECTION 73-21-211, MISSISSIPPI CODE OF 1972, TO CREATE THE PHARMACY FAIR COMPETITION ACT; TO CREATE NEW SECTION 73-21-213, MISSISSIPPI CODE OF 1972, TO PROVIDE LEGISLATIVE FINDINGS; TO CREATE NEW SECTION 73-21-215, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER FROM ACQUIRING DIRECT OR INDIRECT INTEREST IN, OR OTHERWISE HOLDING, DIRECTLY OR INDIRECTLY, A PHARMACY PERMIT FOR THE RETAIL SALE OF DRUGS OR MEDICINES IN THIS STATE; TO AUTHORIZE THE BOARD TO ISSUE A LIMITED USE PERMIT UPON A DETERMINATION THAT CERTAIN RARE, ORPHAN OR LIMITED DISTRIBUTION DRUGS ARE OTHERWISE UNAVAILABLE IN THE MARKET; TO CREATE NEW SECTION 73-21-217, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD TO CONDUCT ASSESSMENTS OF EACH ACTIVE RETAIL PHARMACY PERMITS AND TO PROVIDE WRITTEN NOTICE TO PERMIT HOLDERS THAT THE BOARD REASONABLY BELIEVES WILL VIOLATE THIS ACT; TO AMEND SECTION 25-15-301, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE EXECUTIVE DIRECTOR OF THE BOARD, OR HIS OR HER DESIGNEE, SHALL BE A MEMBER OF THE EVALUATION COMMITTEE WHEN THE PROPOSAL FOR EVALUATION IS FOR PHARMACY BENEFITS OR THE MANAGEMENT THEREOF; TO AMEND SECTION 25-15-303, MISSISSIPPI CODE OF 1972, TO ADD THE EXECUTIVE DIRECTOR OF THE BOARD, OR HIS OR HER DESIGNEE; TO THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD; AND FOR RELATED PURPOSES.
By setting stringent guidelines on how PBMs operate and dictate payments for pharmacy services, SB2575 aims to foster a more equitable healthcare landscape in the state. It prohibits PBMs from engaging in 'spread pricing'—a practice where PBMs charge patients and payers a higher amount than what is reimbursed to their contracted pharmacies. This could have a substantial impact on lowering the costs patients face at the pharmacy, aligning reimbursement practices more closely with the actual acquisition costs for medications. Furthermore, the establishment of an administrative appeal process allows pharmacies to contest reimbursement amounts deemed insufficient, thereby protecting their financial viability and ensuring fair compensation for services rendered.
Senate Bill 2575, known as the Pharmacy Benefit Prompt Pay Act, proposes significant revisions to existing laws governing the operations of pharmacy benefit managers (PBMs) in Mississippi. The bill seeks to amend several sections of the Mississippi Code to enhance transparency and regulation surrounding the reimbursement processes for pharmacies and pharmacists. A particular focus is on the establishment of fair reimbursement rates for prescription drugs dispensed by pharmacies, ensuring that these rates are not only timely but also reflective of the actual costs incurred by pharmacies when providing these services. Moreover, the act introduces a uniform maximum allowable cost list that PBMs must adhere to when determining what a pharmacy can be reimbursed for a given medication.
Despite the bill's intentions to improve transparency and fairness, there is potential for contention around the limits imposed on PBMs. Some stakeholders in the pharmaceutical supply chain may argue that these changes could reduce their flexibility in negotiating prices with manufacturers and managing costs. Additionally, the requirement for an annual report from PBMs on rebates and other payments they receive from pharmaceutical companies may stir concerns about proprietary information and business confidentiality. The ultimate effects of SB2575 will emerge as pharmacies and PBMs navigate the new regulatory landscape whilst trying to balance healthcare access and sustainability.