Text: SSB1046            Text: SSB1048


Senate Study Bill 1047

SENATE FILE BY (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON CONNOLLY) Passed Senate, Date Passed House, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act relating to the regulation of pharmacy benefit management 2 companies and making appropriations. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1643SC 82 5 pf/cf/24 PAG LIN 1 1 Section 1. NEW SECTION. 155B.1 SHORT TITLE. 1 2 This chapter shall be known and may be cited as the 1 3 "Pharmacy Benefit Management Company Regulation Act". 1 4 Sec. 2. NEW SECTION. 155B.2 PURPOSE AND INTENT. 1 5 The purposes of this chapter are: 1 6 1. To establish standards and criteria for the regulation 1 7 and licensing of pharmacy benefit management companies. 1 8 2. To promote, preserve, and protect the public health, 1 9 safety, and welfare by and through effective regulation and 1 10 licensing of pharmacy benefit management companies. 1 11 Sec. 3. NEW SECTION. 155B.3 DEFINITIONS. 1 12 For purposes of this chapter, unless the context otherwise 1 13 requires: 1 14 1. "Board of pharmacy" or "board" means the board of 1 15 pharmacy examiners. 1 16 2. "Cease and desist order" means an order of the board 1 17 prohibiting a pharmacy benefit management company or other 1 18 person from continuing a particular course of conduct which 1 19 violates this chapter or the rules adopted under this chapter. 1 20 3. "Commissioner" means the commissioner of insurance. 1 21 4. "Enrollee" means an individual who is enrolled in a 1 22 pharmacy benefit management plan. 1 23 5. "Health insurance plan or contract" means a third=party 1 24 payment provider contract or policy that is an individual or 1 25 group policy of accident or health insurance or individual or 1 26 group hospital or health care services contract issued 1 27 pursuant to chapter 509, 509A, 514, or 514A, or an individual 1 28 or group health maintenance organization contract issued and 1 29 regulated under chapter 514B. 1 30 6. "Insolvent" or "insolvency" means a financial situation 1 31 in which, based upon the financial information required by 1 32 this chapter for the preparation of a pharmacy benefit 1 33 management company's annual statement, the assets of the 1 34 pharmacy benefit management company are less than the sum of 1 35 all the company's liabilities and required reserves. 2 1 7. "Pharmacist" means pharmacist as defined in section 2 2 155A.3. 2 3 8. "Pharmacists' services" include drug therapy and other 2 4 patient care services provided by a licensed pharmacist 2 5 intended to achieve outcomes related to the cure or prevention 2 6 of a disease, elimination or reduction of a patient's 2 7 symptoms, or arresting or slowing of a disease process as 2 8 defined by rule of the board. 2 9 9. "Pharmacy" means pharmacy as defined in section 155A.3. 2 10 10. "Pharmacy benefit management company" means an entity 2 11 that administers the prescription drug or device portion of a 2 12 health insurance plan or contract on behalf of the sponsors of 2 13 the health insurance plan or contract. 2 14 11. "Pharmacy benefit management plan" means an 2 15 arrangement for the delivery of prescription services in which 2 16 a pharmacy benefit management company provides, arranges for, 2 17 pays for, or reimburses any of the costs of prescription 2 18 services for an enrollee on a prepaid or insured basis which 2 19 provides all of the following: 2 20 a. Contains one or more incentive arrangements intended to 2 21 influence the cost or level of prescription services between 2 22 the plan sponsor and one or more pharmacies with respect to 2 23 the delivery of prescription services. 2 24 b. Requires or creates benefit payment differential 2 25 incentives for enrollees to use under contract with the 2 26 pharmacy benefit management company. 2 27 "Pharmacy benefit management plan" does not mean an 2 28 employee welfare benefit plan as defined in the federal 2 29 Employee Retirement Income Security Act of 1974, 29 U.S.C. } 2 30 1002(1), which is self=insured or self=funded. 2 31 Sec. 4. NEW SECTION. 155B.4 CERTIFICATE OF AUTHORITY. 2 32 1. A person shall not establish or operate a pharmacy 2 33 benefit management company in this state to provide pharmacy 2 34 benefit management plans without first obtaining a certificate 2 35 of authority from the board of pharmacy examiners. A pharmacy 3 1 benefit management company providing pharmacy benefit 3 2 management plans in this state shall obtain a certificate of 3 3 authority from the board every four years. 3 4 2. A person may apply to the board to obtain a certificate 3 5 of authority to establish and operate a pharmacy benefit 3 6 management company in compliance with this chapter if the 3 7 person obtains an annual license to do business in this state 3 8 from the commissioner under section 155B.5. 3 9 3. The board may suspend or revoke a certificate of 3 10 authority issued to a pharmacy benefit management company 3 11 under this chapter or may deny an application for a 3 12 certificate of authority if the board finds any of the 3 13 following: 3 14 a. The pharmacy benefit management company is operating 3 15 significantly in contravention of its basic organizational 3 16 document. 3 17 b. The pharmacy benefit management company does not 3 18 arrange for pharmacists' services. 3 19 c. The pharmacy benefit management company has failed to 3 20 meet the requirements for issuance of a certificate of 3 21 authority established in this chapter. 3 22 d. The pharmacy benefit management company is unable to 3 23 fulfill its obligation to furnish pharmacists' services as 3 24 required under its pharmacy benefit management plan. 3 25 e. The pharmacy benefit management company is no longer 3 26 financially responsible and may reasonably be expected to be 3 27 unable to meet its obligations to enrollees or prospective 3 28 enrollees. 3 29 f. The pharmacy benefit management company, or any person 3 30 on the company's behalf, has advertised or merchandised its 3 31 services in an untrue, misrepresentative, misleading, 3 32 deceptive, or unfair manner. 3 33 g. The continued operation of the pharmacy benefit 3 34 management company would be hazardous to its enrollees. 3 35 h. The pharmacy benefit management company has failed to 4 1 file an annual statement with the commissioner in a timely 4 2 manner. 4 3 i. The pharmacy benefit management company has otherwise 4 4 failed to substantially comply with this chapter. 4 5 4. When the certificate of authority of a pharmacy benefit 4 6 management company is revoked, the company shall proceed, 4 7 immediately following the effective date of the order of 4 8 revocation, to conclude the company's affairs and shall 4 9 conduct no further business except as may be essential to the 4 10 orderly conclusion of the affairs of the company. The board 4 11 may permit further operation of the company as the board may 4 12 find to be in the best interest of enrollees so that the 4 13 enrollees will be afforded the greatest practicable 4 14 opportunity to obtain pharmacists' services. 4 15 Sec. 5. NEW SECTION. 155B.5 LICENSE TO DO BUSINESS. 4 16 1. The commissioner shall not issue an annual license to 4 17 do business in this state to any pharmacy benefit management 4 18 company providing pharmacy benefit management plans until the 4 19 commissioner is satisfied that the pharmacy benefit management 4 20 company has complied with all of the following: 4 21 a. Paid all fees, taxes, and charges required by law. 4 22 b. Has made any deposit required by this chapter. 4 23 c. Has the minimum capital and surplus requirements 4 24 specified by the commissioner. 4 25 d. Has filed any necessary financial statement and any 4 26 reports, certificates, or other documents the commissioner 4 27 considers necessary to secure a full and accurate knowledge of 4 28 the company's affairs and financial condition. 4 29 e. Is solvent, and the company's financial condition, 4 30 method of operation, and manner of doing business satisfy the 4 31 commissioner that the company can meet the company's 4 32 obligations to all enrollees. 4 33 f. Has otherwise complied with all the requirements of 4 34 law. 4 35 2. The license shall be in addition to the certificate of 5 1 authority required by the board. A nonrefundable license 5 2 application fee of five hundred dollars shall accompany each 5 3 application for a license to transact business in this state. 5 4 The fee shall be collected by the commissioner and shall be 5 5 deposited in the pharmacy benefit management company fund 5 6 created in section 155B.15. 5 7 3. The license shall be signed by the commissioner or the 5 8 commissioner's agent and shall expire on the next June 30 5 9 after the date on which the license becomes effective. 5 10 4. A pharmacy benefit management company providing 5 11 pharmacy benefit management plans shall obtain an annual 5 12 renewal of the company's license from the commissioner. The 5 13 commissioner may refuse to renew the license of any pharmacy 5 14 benefit management company or may renew the license, subject 5 15 to any restrictions considered appropriate by the 5 16 commissioner, if the commissioner finds an impairment of 5 17 required capital and surplus, or if the commissioner finds 5 18 that the pharmacy benefit management company has not satisfied 5 19 all the conditions specified in this chapter. The 5 20 commissioner shall not fail to renew the license of any 5 21 pharmacy benefit management company to transact business in 5 22 this state without providing the pharmacy benefit management 5 23 company ten days' notice and providing the company an 5 24 opportunity to be heard. The hearing may be informal, and the 5 25 commissioner and the pharmacy benefit management company may 5 26 waive the required notice. 5 27 Sec. 6. NEW SECTION. 155B.6 ANNUAL STATEMENT. 5 28 1. A pharmacy benefit management company providing 5 29 pharmacy management benefit plans in this state shall file a 5 30 statement with the commissioner annually by March 1. The 5 31 statement shall be verified by at least two principal officers 5 32 of the pharmacy benefit management company and shall cover the 5 33 preceding calendar year. The pharmacy benefit management 5 34 company shall also submit a copy of the statement to the 5 35 board. 6 1 2. The statement shall be on forms prescribed by the 6 2 commissioner and shall include all of the following: 6 3 a. A financial statement of the company, including its 6 4 balance sheet and income statement for the preceding year. 6 5 b. The number of persons enrolled during the year, the 6 6 number of enrollees as of the end of the year, and the number 6 7 of enrollments terminated during the year. 6 8 c. Any other information relating to the operations of the 6 9 pharmacy benefit management company required by the 6 10 commissioner pursuant to this chapter. 6 11 3. If the pharmacy benefit management company is audited 6 12 annually by an independent certified public accountant, a copy 6 13 of the certified audit report shall be filed annually with the 6 14 commissioner by June 30. 6 15 4. The commissioner may extend the time prescribed for any 6 16 pharmacy benefit management company for filing an annual 6 17 statement or other reports, or exhibits of the statement or 6 18 report for good cause shown. However, the commissioner shall 6 19 not extend the time for filing annual statements beyond sixty 6 20 days after the time prescribed by subsection 1. A pharmacy 6 21 benefit management company which fails to file its annual 6 22 statement within the time prescribed by this section may have 6 23 its license revoked by the commissioner or its certificate of 6 24 authority revoked or suspended by the board until the annual 6 25 statement is filed. 6 26 Sec. 7. NEW SECTION. 155B.7 FINANCIAL EXAMINATION. 6 27 1. In lieu of or in addition to performing a financial 6 28 examination of a pharmacy benefit management company, the 6 29 commissioner may accept the report of a financial examination 6 30 by another person responsible for pharmacy benefit management 6 31 companies under the laws of another state who is certified by 6 32 the insurance supervisory official, similar regulatory agency, 6 33 or the state health commissioner of the other state. 6 34 2. The commissioner shall coordinate financial 6 35 examinations of pharmacy benefit management companies that 7 1 provide pharmacy management benefit plans in this state to 7 2 ensure an appropriate level of regulatory oversight and to 7 3 avoid any undue duplication of effort or regulation. The 7 4 pharmacy benefit management company being examined shall pay 7 5 the cost of the examination. Payments of the cost of the 7 6 examination shall be collected by the commissioner and shall 7 7 be deposited in the pharmacy benefit management company fund 7 8 created in section 155B.15. 7 9 Sec. 8. NEW SECTION. 155B.8 ASSESSMENT. 7 10 1. The expense of administering this chapter, including 7 11 the costs incurred by the commissioner and the board, shall be 7 12 assessed annually by the board against all pharmacy benefit 7 13 management companies operating in this state. Before 7 14 determining the assessment, the board shall request from the 7 15 commissioner an estimate of all expenses for the regulation, 7 16 supervision, and examination of all entities subject to 7 17 regulation under this chapter. The assessment shall be in 7 18 proportion to the business done in this state. 7 19 2. Assessments shall be collected by the commissioner and 7 20 shall be deposited in the pharmacy benefit management company 7 21 fund created in section 155B.15. 7 22 3. The board shall provide each pharmacy benefit 7 23 management company notice of the assessment, which shall be 7 24 paid to the board on or before March 1 of each year. A 7 25 pharmacy benefit management company that fails to pay the 7 26 assessment on or before the date prescribed shall be subject 7 27 to a penalty imposed by the board which is ten percent of the 7 28 assessment and interest for the period between the due date 7 29 and the date of full payment. If a payment is made in an 7 30 amount later found to be in error, the following shall apply: 7 31 a. If the error found is an underpayment and an additional 7 32 amount is due, the commission shall notify the company of the 7 33 additional amount and the company shall pay the additional 7 34 amount within fourteen days of the date of the notice. 7 35 b. If the error found is an overpayment, a refund shall be 8 1 ordered. 8 2 4. If an assessment made under this chapter is not paid to 8 3 the board by the prescribed date, the amount of the 8 4 assessment, penalty, and interest may be recovered from the 8 5 defaulting company on motion of the board made in the name and 8 6 for the use of the state in the appropriate court after ten 8 7 days' notice to the company. The certificate of authority of 8 8 a defaulting company to transact business in this state may be 8 9 revoked or suspended by the board until the company has paid 8 10 the assessment. 8 11 Sec. 9. NEW SECTION. 155B.9 PHARMACY BENEFIT MANAGER 8 12 CONTRACTS. 8 13 1. A pharmacy benefit management company that contracts 8 14 with a pharmacy or pharmacist to provide pharmacists' services 8 15 through a pharmacy management plan for enrollees in this state 8 16 shall file the contract with the board thirty days before the 8 17 execution of the contract. The contract shall be deemed 8 18 approved unless the board disapproves the contract within 8 19 thirty days after the contract is filed with the board. 8 20 2. Disapproval of the contract shall be in writing, 8 21 stating the reasons for the disapproval, and a copy of the 8 22 written disapproval shall be delivered to the pharmacy benefit 8 23 management company. 8 24 3. The board, consistent with the board's responsibility 8 25 for protecting the public interest, shall develop formal 8 26 criteria for the approval and disapproval of pharmacy benefit 8 27 management company contracts. 8 28 Sec. 10. NEW SECTION. 155B.10 ENFORCEMENT. 8 29 1. The board shall develop formal investigation and 8 30 compliance procedures for responding to complaints by health 8 31 insurance plans or contract sponsors, pharmacists, or 8 32 enrollees concerning the failure of a pharmacy benefit 8 33 management company to comply with this chapter. If, based 8 34 upon an investigation or complaint, the board has reason to 8 35 believe that there is a violation of this chapter, the board 9 1 shall issue and serve upon the pharmacy benefit management 9 2 company concerned a statement of the charges and a notice of a 9 3 hearing to be held at a time and place fixed in the notice, 9 4 which shall not be less than thirty days after notice is 9 5 served. The notice shall require the pharmacy benefit 9 6 management company to show cause why an order should not be 9 7 issued directing the company to cease and desist from the 9 8 violation. At the hearing, the pharmacy benefit management 9 9 company or the pharmacy benefit manager shall have an 9 10 opportunity to be heard and to show cause why an order should 9 11 not be issued requiring the pharmacy benefit management 9 12 company or the pharmacy benefit manager to cease and desist 9 13 from the violation. 9 14 2. The board may perform an examination concerning the 9 15 quality of services of any pharmacy benefit management company 9 16 and providers with whom the pharmacy benefit management 9 17 company has contracts, agreements, or other arrangements 9 18 pursuant to its pharmacy benefit management plan as often as 9 19 the board deems necessary for the protection of the interests 9 20 of the people of this state. The pharmacy benefit management 9 21 company being examined shall pay the cost of the examination. 9 22 Sec. 11. NEW SECTION. 155B.11 PROHIBITED PRACTICES. 9 23 1. A pharmacy benefit management company or its 9 24 representative shall not cause or knowingly permit any of the 9 25 following: 9 26 a. The use of advertising that is untrue or misleading. 9 27 b. Solicitation that is untrue or misleading. 9 28 c. Any form of evidence of coverage that is deceptive. 9 29 2. A pharmacy benefit management company, unless licensed 9 30 as an insurer, shall not use in its name, contracts, or 9 31 literature any of the following: 9 32 a. Any form of the word "insurance", "casualty", "surety", 9 33 or "mutual". 9 34 b. Any other words descriptive of the insurance, casualty, 9 35 or surety business, or deceptively similar to the name or 10 1 description of any insurer or fidelity and surety insurer, 10 2 doing business in this state. 10 3 3. A pharmacy benefit management company shall not 10 4 discriminate on the basis of race, creed, color, sex, or 10 5 religion in the selection of pharmacies with whom the company 10 6 does business. 10 7 4. A pharmacy benefit management company shall not 10 8 unfairly discriminate against pharmacists when contracting for 10 9 pharmacists' services. 10 10 Sec. 12. NEW SECTION. 155B.12 DISCLOSURES. 10 11 The following shall be provided to the pharmacy benefit 10 12 management company's enrollees at the time of enrollment or at 10 13 the time the contract is issued and shall be made available 10 14 upon request or at least annually: 10 15 1. A list of the names and locations of all affiliated 10 16 pharmacists' services providers. 10 17 2. A description of the service area or areas within which 10 18 the pharmacy benefit management company provides prescription 10 19 services. 10 20 3. A description of the method of resolving complaints of 10 21 covered persons, including a description of any arbitration 10 22 procedure if complaints may be resolved through a specified 10 23 arbitration agreement. 10 24 4. Notice that the pharmacy benefit management company is 10 25 subject to regulation in this state by both the board of 10 26 pharmacy examiners and the commissioner of insurance. 10 27 5. A prominent notice included within the evidence of 10 28 coverage, providing substantially the following: "If you have 10 29 any questions regarding an appeal or grievance concerning the 10 30 pharmacists' services that you have been provided, which have 10 31 not been satisfactorily addressed by your plan, you may 10 32 contact the board of pharmacy examiners." The notice shall 10 33 also provide the toll=free telephone number, mailing address, 10 34 and electronic mail address of the board of pharmacy 10 35 examiners. 11 1 Sec. 13. NEW SECTION. 155B.13 PRIVACY. 11 2 An enrollee has the right to privacy and confidentiality in 11 3 the provision of pharmacists' services. This right may be 11 4 expressly waived in writing by the enrollee or the enrollee's 11 5 guardian. 11 6 Sec. 14. NEW SECTION. 155B.14 INSOLVENCY. 11 7 1. If a pharmacy benefit management company becomes 11 8 insolvent or ceases to be a company in this state in any 11 9 assessable or license year, the company shall remain liable 11 10 for the payment of the assessment for the period in which the 11 11 company operated as a pharmacy benefit management company in 11 12 this state. 11 13 2. If a pharmacy benefit management company becomes 11 14 insolvent, the commissioner may, after notice and hearing, 11 15 levy an assessment, in addition to an assessment pursuant to 11 16 section 155B.8, on pharmacy benefit management companies 11 17 licensed to do business in this state. The assessments shall 11 18 be paid quarterly to the commissioner, and upon receipt by the 11 19 commissioner shall be paid over into an escrow account in the 11 20 pharmacy benefit management company fund. The escrow account 11 21 shall be used solely for the benefit of enrollees of the 11 22 insolvent pharmacy benefit management company. 11 23 Sec. 15. NEW SECTION. 155B.15 PHARMACY BENEFIT 11 24 MANAGEMENT COMPANY FUND == USES == ESCROW ACCOUNT. 11 25 1. A pharmacy benefit management company fund is created 11 26 in the state treasury under the authority of the commissioner 11 27 of insurance. Moneys received from licensure of pharmacy 11 28 benefit management companies pursuant to section 155B.5, from 11 29 examinations collected pursuant to section 155B.7, and from 11 30 assessments collected pursuant to section 155B.8, shall be 11 31 deposited in the fund. Moneys in the fund shall be used and 11 32 an amount necessary is appropriated, annually, to the division 11 33 of insurance of the department of commerce for the purposes of 11 34 enforcing this chapter. 11 35 2. An escrow account is created in the pharmacy benefit 12 1 management company fund. Assessments collected pursuant to 12 2 section 155B.14 shall be deposited in the account and are 12 3 appropriated to the division of insurance of the department of 12 4 commerce to be used solely for the benefit of the enrollees of 12 5 an insolvent pharmacy benefit management company. 12 6 EXPLANATION 12 7 This bill establishes regulation of pharmacy benefit 12 8 management companies. The bill defines terms used in the 12 9 bill, including "pharmacy benefit management company" (PBM), 12 10 which is an entity that administers the prescription drug or 12 11 device portion of a health insurance plan or contract on 12 12 behalf of the sponsors of the health insurance plan or 12 13 contract. The bill requires a PBM to obtain a certificate of 12 14 authority from the board of pharmacy examiners every four 12 15 years. A prerequisite for obtaining a certificate of 12 16 authority is the obtaining of a license to do business in the 12 17 state from the commissioner of insurance. The bill provides 12 18 criteria that the board may use to suspend or revoke a PBM's 12 19 certificate of authority. 12 20 The bill requires a PBM to obtain a license to do business 12 21 from the commissioner of insurance. Issuance of the license 12 22 is based on a determination by the commissioner that the PBM 12 23 is financially sound. A PBM is required to pay a license 12 24 application fee of $500. The license expires every June 30 12 25 following the date of issuance. 12 26 The bill requires a PBM to file an annual statement with 12 27 the commissioner of insurance by March 1, and also provide a 12 28 copy of the statement to the board of pharmacy examiners. The 12 29 annual statement is to be verified by at least two principal 12 30 officers of the PBM, cover the preceding calendar year, and 12 31 include: a financial statement of the company, including its 12 32 balance sheet and income statement for the preceding year; the 12 33 number of persons enrolled during the year, the number of 12 34 enrollees as of the end of the year, and the number of 12 35 enrollments terminated during the year; and any other 13 1 information relating to the operations of the PBM required by 13 2 the commissioner pursuant to the bill. If the PBM is audited 13 3 annually by an independent certified public accountant, a copy 13 4 of the certified audit report is to be filed annually with the 13 5 commissioner by June 30. The bill provides for an extension 13 6 in the time prescribed for submission of the annual statement 13 7 or other reports by the insurance commissioner for good cause 13 8 shown. If a PBM fails to file the annual statement in the 13 9 prescribed time, the commissioner may revoke its license and 13 10 the board may suspend or revoke the certificate of authority. 13 11 The bill provides for the coordination of financial 13 12 examinations of PBMs, provides that the PBM is to pay the cost 13 13 of the examination, and provides that the payments collected 13 14 are to be deposited in the pharmacy benefit management company 13 15 fund created in the bill. 13 16 The bill provides that the expenses of administering the 13 17 regulation of PBMs, including the costs incurred by the 13 18 commissioner and the board, shall be assessed annually by the 13 19 board against all pharmacy benefit management companies 13 20 operating in the state. The assessment is to be based upon 13 21 the commissioner's estimate, provided to the board, of all 13 22 expenses for the regulation, supervision, and examination of 13 23 all entities subject to regulation. Assessments are to be 13 24 collected by the commissioner by March 1, annually, and are to 13 25 be deposited in the pharmacy benefit management company fund 13 26 created in the bill. The bill directs the board to provide 13 27 each pharmacy benefit management company notice of the 13 28 assessment. A pharmacy benefit management company that fails 13 29 to pay the assessment on or before the date prescribed is 13 30 subject to a penalty imposed by the board which is 10 percent 13 31 of the assessment and interest for the period between the due 13 32 date and the date of full payment. The bill provides for 13 33 payment of additional amounts or refunds if a payment is made 13 34 in an amount later found to be in error. If an assessment is 13 35 not paid to the board by the prescribed date, the amount of 14 1 the assessment, penalty, and interest may be recovered and the 14 2 certificate of authority of any defaulting company to transact 14 3 business in this state may be revoked or suspended by the 14 4 board until the company has paid the assessment. 14 5 The bill requires a PBM that contracts with a pharmacy or 14 6 pharmacist to provide pharmacists' services to file the 14 7 contract with the board 30 days before the execution of the 14 8 contract. The contract is deemed approved unless the board 14 9 disapproves the contract within 30 days after the contract is 14 10 filed with the board. Disapproval of the contract is to be in 14 11 writing and a copy is to be delivered to the PBM. The bill 14 12 directs the board to develop formal criteria for the approval 14 13 and disapproval of PBM contracts. 14 14 The bill provides for enforcement of the new Code chapter, 14 15 specifies prohibited practices by PBMs, requires PBMs to make 14 16 certain disclosures to enrollees, and provides that enrollees 14 17 have the right to privacy and confidentiality in the provision 14 18 of pharmacists' services which right may be expressly waived 14 19 in writing by the enrollee or the enrollee's guardian. The 14 20 bill provides that if a PBM becomes insolvent or ceases to be 14 21 a company in this state in any assessable or license year, the 14 22 company remains liable for the payment of the assessment for 14 23 the period in which the company operated as a PBM in the 14 24 state. The bill also provides that if a PBM becomes 14 25 insolvent, the commissioner may, after notice and hearing, 14 26 levy an additional assessment on PBMs licensed to do business 14 27 in the state. The assessments are to be paid quarterly to the 14 28 commissioner, deposited in an escrow account in the pharmacy 14 29 benefit management company fund, and are to be used solely for 14 30 the benefit of enrollees of the insolvent PBM. 14 31 The bill creates the pharmacy benefit management company 14 32 fund in the state treasury under the authority of the 14 33 commissioner of insurance. Moneys received from licensure of 14 34 pharmacy benefit management companies pursuant to Code section 14 35 155B.5, from examination fees collected pursuant to Code 15 1 section 155B.7, and from assessments collected pursuant to 15 2 Code section 155B.8 are deposited in the fund. Moneys in the 15 3 fund are to be used and an amount necessary is appropriated, 15 4 annually, to the division of insurance of the department of 15 5 commerce for the purposes of enforcing the provisions of the 15 6 bill. The bill also creates an escrow account within the 15 7 fund. Assessments collected relative to an insolvent PBM are 15 8 to be deposited in the account and are to be used solely for 15 9 the benefit of the enrollees of the insolvent PBM. 15 10 LSB 1643SC 82 15 11 pf:nh/cf/24
Text: SSB1046            Text: SSB1048