Reporting by pharmacy benefit managers. Requires pharmacy benefit managers to report annually specified information to the commissioner of the department of insurance. Requires the commissioner to post the information on the department of insurance's Internet web site.
Drug information reporting. Requires prescription drug manufacturers, health insurance issuers, pharmacy benefits managers, and wholesale drug distributors (reporting entities) to report certain information to the department of insurance (department), including increases in the wholesale acquisition cost of brand name drugs and generic drugs, the introduction into the United States of a new drug, and spending on prescription drugs before enrollee cost sharing for each of the top 25 prescription drugs and drug groups. Requires reporting entities to pay an annual assessment to support the operational costs incurred by the department in connection with the [...]
Pharmacy benefit managers. Requires a pharmacy benefit manager to obtain a license issued by the department of insurance and sets forth requirements of the pharmacy benefit manager. Provides for the commissioner of the department of insurance to adopt rules to specify licensure, financial standards, and reporting requirements that apply to a pharmacy benefit manager. Sets forth requirements and prohibitions of a pharmacy benefit manager. Allows a party that has contracted with a pharmacy benefit manager to request an audit of compliance at least one time per year. Makes violations of the chapter concerning pharmacy [...]
Health and insurance matters. Establishes the importation of prescription drugs program (program) for the importation of prescription drugs to be administered by the state department of health (state department). Requires the state department to apply to the federal government for approval of the program. Sets forth requirements for the vendor of the program. Sets requirements for suppliers, importers, and wholesale drug distributors of the program. Requires the state department to submit reports to the governor and the general assembly concerning the program. Establishes for participants in the program an international export pharmacy permit and [...]
Ambulatory surgical centers. Provides that ambulatory surgical centers may be reimbursed in an amount not to exceed 275% of the ambulatory surgical center's Medicare reimbursement rate. Provides that the payment to an ambulatory surgical center for a medical device under worker's compensation may not exceed the invoice amount plus 3%. Increases benefits for injuries and disablements by 2% each year for three years, beginning on July 1, 2020. Provides that a medical service facility may be reimbursed in an amount not to exceed 200% of the medical service facility's Medicare reimbursement rate.
Health care provider billing. Prohibits billing a patient who receives emergency services: (1) from an out of network provider; and (2) at specified facilities that are in network; for amounts that exceed the cost paid by the patient's insurance plus any deductibles, copayments, and coinsurance amounts. Requires certain health care providers to provide, upon request from the patient, a good faith estimate to the patient for the cost of care at least five business days before a health care service or procedure is provided. Sets forth requirements of the good faith estimate. Requires the [...]
Health care provider billing requirements. Requires a hospital or ambulatory outpatient surgical center to provide a patient written notice before a service may be provided if the provider who is to provide the service is out of the patient's health plan network. Requires the patient to acknowledge receipt of the notice and either agree or decline to receive the service from an out of network provider. Specifies options if the patient declines to receive the services from an out of network provider. Includes transportation services as an included service for purposes of the notice [...]
Health care costs. Requires a hospital or ambulatory outpatient surgical center to provide each patient, patient's guardian, or patient's health care representative with a good faith estimate (estimate) of all charges and fees associated with certain medical procedures and services. Requires an estimate to be provided to a patient upon: (1) the patient's discharge from the hospital or ambulatory outpatient surgical center; or (2) the conclusion of a medical examination or procedure. Specifies that an estimate is not a legally binding contract or estimate concerning the: (1) allowable; (2) total; or (3) final; cost [...]
Physicians who leave an employer. Provides that a physician noncompete agreement, to be enforceable, must contain the following provisions: (1) A provision requiring the physician's employer to provide the physician with a copy of any notice that: (A) concerns the physician's departure; and (B) was sent to a patient seen or treated by the physician during the two years preceding the termination of the physician's employment or expiration of the departing physician's contract. (2) A provision requiring the physician's employer to provide current or last known contact and location information to a patient seen [...]
Provides that the state employee health plan statute does not prohibit the state personnel department from directly contracting with health care providers for health care services for state employees. Defines "health carrier" for purposes of the law on health provider contracts. Requires a hospital to post pricing information in compliance with the federal Hospital Price Transparency Rule of the Centers for Medicare and Medicaid Services as in effect on January 1, 2021, if: (1) the federal Hospital Price Transparency Rule is repealed; or (2) federal enforcement of the federal Hospital Price Transparency Rule is [...]
