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215 Ill. Comp. Stat. §§ 124/1 through 124/25: Network Adequacy and Transparency Act – Illinois
Status: Enacted     Year Enacted: 2017
Statutes prohibit an insurer from prohibiting a preferred provider from discussing any specific or all treatment options with beneficiaries or from advocating on behalf of beneficiaries within utilization review. If the insurer does not have …
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27 R.I. Gen. Laws § 27-41-14.1. Prohibition against restraint on provider-patient communications: Health Maintenance Organization Act – Rhode Island
Status: Enacted     Year Enacted: 1997
No health maintenance organization shall refuse to contract with or compensate for covered services an otherwise eligible health care provider solely because the provider has in good faith communicated with one or more of his …
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40 Pa. Cons. Stat. § 991.2113. Medical gag clause prohibition: Managed Care Plan Requirements – Pennsylvania
Status: Enacted     Year Enacted: 1998
Statute that prohibits medical gag clauses.
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40 Pa. Stat. and Pa. Cons. Stat. Ann. §§ 991.2101 through 991.2194: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted     Year Enacted: 1998
Provisions governing managed care plans to ensure quality health care including prohibitions on financial incentives and gag clauses, standards regarding utilization review, prompt paymen of claims, and general responsibilities of managed care plans. Requires the …
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A 2214 (see companion bill S 2690; combined with A 3993) – New Jersey
Introduced: 2018    Status: Inactive / Dead    
PROHIBITS PHARAMCY BENEFIT MANAGERS FROM COLLECTING COPAYMENTS IN EXCESS OF CERTAIN AMOUNTS “CLAWBACKS”; REQUIRES CERTAIN LANGUAGE PROHIBITNG “GAG CLAUSES” IN CONTRACTS WITH PHARMACISTS: Prohibits a pharmacy benefits manager, in connection with any contract or arrangement …

A 3659 (see companion bill S 1007) – New York
Introduced: 2021    Status: In Process    
Prohibits an insurer or health maintenance organization from including certain requirements in insurance contracts. The legislation would ban anti-competitive hospital contracting practices that create higher health care prices for consumers and employers. Section one amends …

A 3993 (see companion bill S 2690; combined with A 2214) – New Jersey
Introduced: 2018    Status: Inactive / Dead    
PROHIBITS PHARMACY BENEFIT MANAGERS FROM COLLECTING “CLAWBACK” COPAYMENTS; PROHIBITS “GAG CLAUSES” IN CONTRACTS WITH PHARMACISTS; PROVIDES CERTAIN PENALTES. A pharmacy benefits manager, in connection with any contract or arrangement with a private health insurer, prescription …

A 4041 (see ompanion bill S 2438) – New Jersey
Introduced: 2018    Status: Inactive / Dead    
Would prohibit “gag clauses” by requiring a pharmacy benefits manager to include in any contract between the pharmacy benefits manager and a pharmacy in the State, language that permits the pharmacy to disclose to a …

A 8046 (see companion bill S 6629) – New York
Introduced: 2018    Status: Inactive / Dead    
Requires pharmacies to provide customers directly with the retail (before insurance) price of a prescription, in writing and electronically prior to purchase.

A 8169 (see companion bill S 7199) – New York
Introduced: 2021    Status: In Process    
Prohibits certain provisions in insurance and HMO contracts that requires the insurer to include within the scope of the contract all covered groups of the insurer for access to the insurer’s network of participating providers …

A 8781 (see companion bill S 6940) – New York
Introduced: 2017    Status: Inactive / Dead    
PHARMACY BENEFIT MANAGERS: Prohibits pharmacy benefit managers from prohibiting pharmacies from disclosing to consumers the cost of prescription medication, the availability of alternative medications or alternative means of purchasing prescription medications; and prohibits pharmacy benefit …

A 9893 (see companion bill S 7191A) – New York
Introduced: 2018    Status: Inactive / Dead    
RELATES TO ENHANCING PHARMACEUTICAL TRANSPARENCY AND CONSUMER PROTECTION: No contract for pharmacy services entered into in the state between a health insurance carrier or a pharmacy benefit manager and a pharmacy, pharmacist or a pharmacy’s …

AB 141 – Nevada
Introduced: 2019    Status: Enacted    
AN ACT relating to pharmacy benefit managers; prohibiting a pharmacy benefit manager from imposing certain limitations on the conduct of a pharmacist or pharmacy; and providing other matters properly relating thereto.

AB 1803 – California
Introduced: 2019    Status: Enacted    
Pharmacy: healthcare coverage: claims for prescription drugs sold for retail price – Existing law, the Pharmacy Law, requires a pharmacy to inform a customer at the point of sale for a covered prescription drug whether …

AB 2352 – California
Introduced: 2022    Status: Enacted    
Prescription drug coverage. This bill would require a health care service plan or health insurer that provides prescription drug benefits and maintains one or more drug formularies to furnish specified information about a prescription drug …

AB 2863 – California
Introduced: 2018    Status: Enacted     Year Enacted: 2018
HEALTH CARE COVERAGE – PRESCRIPTIONS: This bill would limit the amount a health care service plan, health insurer, or pharmacy benefit manager may require an enrollee or insured to pay at the point of sale …

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