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 NEW TERMS AND REVISE THE DEFINITIONS OF EXISTING TERMS UNDER THE PHARMACY BENEFIT PROMPT PAY ACT; TO AMEND SECTION 73-21-155, MISSISSIPPI CODE OF 1972, TO DEFINE A CLEAN CLAIM AND A NETWORK PHARMACY, FOR THE PURPOSE OF THIS SECTION; 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 SHALL MAKE THE ADJUSTMENT EFFECTIVE FOR THE APPEAL AND SHALL PROVIDE NOTICE ON ITS WEBSITE ABOUT THE APPEAL; TO AMEND SECTION 73-21-157, MISSISSIPPI CODE OF 1972, TO REQUIRE A PHARMACY SERVICES ADMINISTRATIVE ORGANIZATION (PSAO) TO BE LICENSED WITH THE MISSISSIPPI BOARD OF PHARMACY; TO CREATE NEW SECTION 73-21-158, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PHARMACY BENEFIT MANAGER, PSAO, CARRIER OR HEALTH PLAN FROM SPREAD PRICING; TO CREATE A NEW SECTION, THAT PROHIBITS PHARMACY BENEFIT MANAGERS FROM PROVIDING FINANCIAL CONSIDERATION TO PHARMACY BENEFIT MANAGER AFFILIATES AT A HIGHER RATE THAN A NONAFFILIATE; TO CREATE NEW SECTION 73-21-162, MISSISSIPPI CODE OF 1972, TO PROHIBIT PHARMACY BENEFIT MANAGERS, PHARMACY BENEFIT MANAGER AFFILIATES AND PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS (PSAOS) FROM PENALIZING OR RETALIATING AGAINST A PHARMACIST, PHARMACY OR PHARMACY EMPLOYEE FOR EXERCISING ANY RIGHTS UNDER THIS ACT, INITIATING ANY JUDICIAL OR REGULATORY ACTIONS, OR APPEARING BEFORE ANY GOVERNMENTAL AGENCY, LEGISLATIVE MEMBER OR BODY OR ANY JUDICIAL AUTHORITY; TO AMEND SECTION 73-21-163, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE BOARD OF PHARMACY, 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 EACH DRUG MANUFACTURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES THE CURRENT WHOLESALE ACQUISITION COST; TO REQUIRE SUCH ENTITIES TO PROVIDE THE BOARD OF PHARMACY WITH VARIOUS DRUG PRICING INFORMATION WITHIN A CERTAIN TIME; TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO FILE A REPORT WITH THE BOARD OF PHARMACY; TO REQUIRE EACH HEALTH INSURER TO SUBMIT A REPORT TO THE BOARD OF PHARMACY THAT INCLUDES CERTAIN DRUG PRESCRIPTION INFORMATION; TO CREATE NEW SECTION 73-21-167, MISSISSIPPI CODE OF 1972, TO REQUIRE THE BOARD OF PHARMACY TO DEVELOP A WEBSITE TO PUBLISH INFORMATION RELATED TO THE ACT; TO CREATE NEW SECTION 73-21-169, MISSISSIPPI CODE OF 1972, TO REQUIRE PHARMACY BENEFIT MANAGERS AND PSAOS TO IDENTIFY OWNERSHIP AFFILIATION OF ANY KIND TO THE BOARD OF PHARMACY; TO CREATE A NEW SECTION THAT CREATES THE MISSISSIPPI INDEPENDENT PHARMACIST REIMBURSEMENT ASSISTANCE GRANT PROGRAM; TO DEFINE TERMS RELEVANT TO THE PROGRAM; TO PROVIDE ELIGIBILITY REQUIREMENTS AND GUIDELINES FOR GRANT AWARDS; TO PROVIDE THAT THE BOARD SHALL ESTABLISH AN APPLICATION PROCESS FOR THE GRANT PROGRAM, AND THAT THE BOARD SHALL HAVE THE AUTHORITY TO PROMULGATE RULES AND REGULATIONS NECESSARY TO ADMINISTERING THE PROGRAM; AND FOR RELATED PURPOSES.
The bill's provisions are expected to create more equitable financial arrangements between PBMs and pharmacies by disallowing spread pricing and mandating more immediate and transparent reimbursement practices. Specifically, it requires PBMs to pay pharmacies for clean claims within a specified timeline of seven days for electronic submissions and thirty-five days for paper claims. This shift is intended to prevent financial strain on pharmacies caused by delayed payments, potentially improving their viability in poor or rural areas where they are often the only healthcare access point for residents.
Senate Bill 2576 is aimed at refining the provisions related to pharmacy benefit managers (PBMs) and their interactions with pharmacies in Mississippi. The legislation seeks to enhance the regulatory framework guiding these entities primarily focusing on transparency and fairness in reimbursement processes for independent pharmacies. A significant component of the bill establishes an Independent Pharmacist Reimbursement Assistance Grant Program intended to support community pharmacies facing financial challenges. This program allows eligible independent pharmacies to apply for funds to alleviate operational costs incurred while servicing underserved populations including Medicaid and Medicare beneficiaries.
Notable points of contention surrounding SB2576 include concerns about the potential administrative burdens it may impose on PBMs, particularly with the increased reporting and auditing requirements aimed at ensuring compliance. Proponents argue that these measures will protect independent pharmacies and ensure fair play within pharmacy benefit management, while critics warn that such regulations may lead to increased operational costs that could be passed onto consumers or weaken competition in the pharmacy market.