Effective Date: 7/22/22
This measure applies to PBMs and third party administrators. This measure prohibits all contracts for a third party that reimbursed for 340B drugs from discriminating in reimbursement, assessing fees or clawbacks, excluding pharmacies from their network, or restricting dispensing or deliver medicines, all solely on the bases that the pharmacy dispenses 340B drugs.

Effective date: 7/26/21
This bill prohibits third parties restricting or placing burdens on using drugs or pharmacies from 340B or restricting choice of pharmacies or attempting to force patients to use a mail-order pharmacy. This bill amends Title 23 Chapter 92. This bill requires third parties to inform patients that they are not required to use mail-order pharmacies and obtain a signed waiver before using a mail-order pharmacy and use the formulary and coverage decisions during normal course of business. Third parties may not restrict patient's freedom to choose a pharmacy and must end any discriminatory contracting relating to drug-pricing savings and pricing that occurs when offering a lower reimbursement for drugs purchased under 340B, refusal to cover 340B drugs, refusal to permit 340B pharmacies in network, and charging more than fair market value for 340B services, or altering the formulary to exclude 340B drugs. The insurance commissioner must promulgate rules to implement this bill. This measure takes effect on July 26, 2021.

This measure prohibits insurers and PBMs from imposing any provisions that discriminate against a covered entity or pharmacy in connection with dispensing covered drugs or that prevent a covered entity from retaining the benefit of discounted pricing for drugs. Prohibited discrimination includes: Payment terms or reimbursement methodologies that distinguish between covered and other drugs, account for the availability of discounts under 340B, or are less favorable than the payment terms or reimbursement methodologies for similarly situated entities not furnishing/dispensing covered drugs. Terms or conditions applied to covered entities based on the furnishing or dispensing of covered drugs or their status as a covered entity or specified pharmacy, including restrictions or requirements for participation in preferred pharmacy networks or requirements related to the scope and frequency of audits. Requiring a covered entity or specified pharmacy to identify covered drugs or covered drug costs. Refusing or terminating contracts with a covered entity or pharmacy on the basis that the pharmacy is a covered entity or specified pharmacy. Retaliation against a pharmacy or covered entity based on exercise of any right or remedy Interfering with an individuals choice to receive a covered drug in person, by mail, or by other form of shipment. Restricting or prohibiting a covered entity from raising a grievance or file a legal action against a payer. This measure does not apply to Medicaid/Medicare plans. 

Effective Date: 8/31/22
The measure enacts the 340B Prescription Drug Program Anti-discrimination Act, which prohibits health insurers, PBMs, and other third-party payers from discriminating against entities, including pharmacies, participating in the federal 340B drug pricing program. These third-party payers will not be able to: 1. Refuse to reimburse a 340B covered entity for dispensing 340B drugs, imposing additional requirements or restrictions on 340B covered entities, or reimbursing a 340B covered entity for a 340B drug at a rate lower than the amount paid for the same drug to pharmacies that are not 340B entities. 2. Assess fees, chargebacks, and adjustments against 340B entities, restricting a 340B covered entity's access to ta pharmacy network because it participates in the program. 3. Requiring a 340B covered entity to contract with a specific pharmacy or health coverage plan in order to access the third-party payer's pharmacy network.4. Imposing a restriction or additional charge in the patient who obtains a drug from a 340B entity.5. Restrict methods where a 340B entity may dispense or deliver the drugs. Any violation of this measure will be recognized as an unfair or deceptive act. 

This measure prohibits any payer from imposing any requirements, conditions, or exclusions that discriminate against a 340B covered entity or a specified pharmacy dispensing covered drugs, or prevent a 340B covered entity from retaining the benefit of discounted pricing for the purchasing covered drugs. This applies to self-insured employee welfare benefits administered through a PBM. This measure requires each hospital that participates in the federal 340B drug pricing program to file the following information: (1) a list of manufacturers from whom the hospital purchased covered outpatient drugs in the preceding year; (2) a list of covered outpatient drugs purchased from each manufacturer; (3) the reimbursement amount by each payer for covered outpatient drugs; (4) the difference in cost for each covered outpatient drug for ceiling price or actual price paid, and the actual price paid by any patient or payer; and (5) a summary on how the difference was applied for the benefit of the community. Federal pricing: This measure requires drug manufacturers to comply with federal pricing requirements when selling covered drugs to 340B covered entities located in the state and prohibits any preconditions, limitations, delays, or other barriers to the purchase of covered drugs. 

Effective Date: 7/01/21
This measure prohibits a pharmacy benefit manager (PBM) from: (1) imposing limits on a pharmacy's access to medication that differ from those existing for a PBM affiliate; or (2) sharing any covered individual's information, except as permitted by the federal Health Insurance Portability and Accountability Act (HIPAA). Prohibits the inclusion of certain provisions in a contract between a PBM and an entity authorized to participate in the federal 340B Drug Pricing Program, with certain exceptions. Requires a PBM: (1) to update the PBM's maximum allowable cost list at least every seven days; (2) to determine that a prescription drug is not obsolete, is generally available for purchase by pharmacies, and is not temporarily unavailable, listed on a drug shortage list, or unable to be lawfully substituted before placing the prescription drug on a maximum allowable cost list. it provides that: (1) if a PBM approves an appeal concerning maximum allowable cost pricing, the PBM must notify each pharmacy in the PBM's network that the maximum allowable cost for the drug has been adjusted; and (2) if a PBM denies an appeal, the PBM must provide the reason for the denial and other information, and the appealing pharmacy or other entity may then file a complaint with the department of insurance (department). it also allows a contracted pharmacy or pharmacy services administrative organization to file a complaint with the department if it believes that its contract with a PBM contains an unlawful contractual provision. A PBM's violation of these requirements or prohibitions is an unfair or deceptive act or practice in the business of insurance. If a party procures a policy of insurance through an online platform: (1) the party affirmatively consents to have all notices and other documents related to the policy delivered to the party electronically; and (2) other statutory prerequisites to the electronic delivery of notices do not apply

Effective Date: 7/1/22
This measure is applicable to pharmacy benefit managers and Medicaid-managed care. Under this measure, a contract between a PBM, third party payer, and a 340B entity may not contain any provisions that: 1. Distinguishes between drugs purchased through the 340B drug discount program and other drugs when determining reimbursement or reimbursement methodologies, or contains otherwise less favorable payment terms or reimbursement methodologies for 340B entities or 340B pharmacies when compared to similarly situated non-340B entities. 2. Imposes a fee, chargeback, or rate adjustment that is not imposed on a pharmacy that is not a 340B entity. Click link to see all provisions.

This measure prohibits group health plans, health insurance carriers, third-party administrators, and pharmacy benefits managers (PBM) from: (1) discriminating against covered entities or contract pharmacies by reimbursing them less for prescription drugs or dispensing fees than they would reimburse other similarly situated entities or pharmacies that are not covered entities or contracted pharmacies; (2) imposing different contractual terms and conditions on covered entities or contract pharmacies participating in the 340B program than those of entities or pharmacies that are not covered entities or contracted pharmacies; (3) placing restrictions or imposing requirements on individuals that choose to obtain a covered outpatient drug from a covered entity or a contract pharmacy; (4) refusing to contract with a covered entity or a contract pharmacy based on any criteria that are not applied equally; and (5) imposing any restriction or condition on a covered entity that interferes with the covered entity’s ability to maximize the value of discounts. The Commissioner of Insurance may adopt rules and issue penalties for violations. 

This measure states that group health plans, health carriers that offer group or individual health insurance coverage, third party administrators, and PBMs: Must not discriminate against a covered entity or a contract pharmacy by reimbursing the covered entity or the contract pharmacy for a prescription drug or a dispensing fee in an amount less than the group health plan, health carrier, third-party administrator, or PBM that reimburses a similarly situated entity or pharmacy that is not a covered entity or a contract pharmacy. Must not place any restrictions or impose any requirements on an individual that chooses to obtain a covered outpatient drug from a covered entity or a contract pharmacy (whether in person or via mail or other delivery). Refuse to contract with a covered entity or a contract pharmacy based on any criteria that is not applied equally to a contract with a similarly situated entity or pharmacy that does not participate in the 340B drug program. This measure states that group health plans, health carriers that offer group or individual health insurance coverage, third party administrators, and PBMs must not, on the basis that an entity is covered entity or that a pharmacy is a contract pharmacy, or that a covered entity or contract pharmacy participate in the 340B program, impose any of the following contractual terms and conditions on the covered entity or the contract pharmacy that differ from those imposed on a similarly situated entity or pharmacy that is not a covered entity or a contract pharmacy: Fees or other assessments that are not required by state law or Iowa administrative code. Chargebacks, clawbacks, or other reimbursement adjustments that are not required by state law or the Iowa administrative code. Professional dispensing fees that are not required by state law or Iowa administrative code. Restrictions or requirements that are not required by state law or Iowa administrative code. Requirements related to the frequency or scope of audits. Requirements related to inventory management systems that utilize generally accepted accounting principles. Requirements related to mandatory disclosure either directly or indirectly through a third party, except disclosures required by federal law, of prescription orders that are filled with covered outpatient drugs obtained through the 340B program. This measure must not be construed to prohibit: Adjustments for overpayments or other errors associated with an adjudicated claim. Requirements related to statutorily required modifiers or other identifiers on claims submitted for drugs purchased through the 340B program. 

This measure prohibits group health plans, health carriers that offer group or individual health insurance coverage, third-party administrators, and PBMs from discriminating against a covered entity or a contract pharmacy by reimbursing the covered entity or contract pharmacy for a prescription drug or a dispensing fee in an amount less than the plan, carrier, administrator, or PBM reimburses a similarly situated entity or pharmacy that is not a covered entity or a contract pharmacy. Must not place any restrictions or impose any requirements on an individual that chooses to obtain a covered outpatient drug from a covered entity or a contract pharmacy (whether in person or via mail or other delivery). Refuse to contract with a covered entity or a contract pharmacy based on any criteria that is not applied equally to a contract with a similarly situated entity or pharmacy that does not participate in the 340B drug program. This measure states that group health plans, health carriers that offer group or individual health insurance coverage, third party administrators, and PBMs must not, on the basis that an entity is covered entity or that a pharmacy is a contract pharmacy, or that a covered entity or contract pharmacy participate in the 340B program, impose any of the following contractual terms and conditions on the covered entity or the contract pharmacy that differ from those imposed on a similarly situated entity or pharmacy that is not a covered entity or a contract pharmacy: Fees or other assessments that are not required by state law or Iowa administrative code.Chargebacks, clawbacks, or other reimbursement adjustments that are not required by state law or the Iowa administrative code. Professional dispensing fees that are not required by state law or Iowa administrative code. Restrictions or requirements that are not required by state law or Iowa administrative code. Requirements related to the frequency or scope of audits. Requirements related to inventory management systems that utilize generally accepted accounting principles. Requirements related to mandatory disclosure either directly or indirectly through a third party, except disclosures required by federal law, of prescription orders that are filled with covered outpatient drugs obtained through the 340B program. This measure must not be construed to prohibit: Adjustments for overpayments or other errors associated with an adjudicated claim. Requirements related to statutorily required modifiers or other identifiers on claims submitted for drugs purchased through the 340B program. EnforcementThe commissioner may establish rules and regulations to implement this measure. If a group health plan, a health carrier that offers group or individual health insurance, a third-party administrator, or a PBM violates this measure, the commissioner may impose penalties. Applicability This measure does not apply to operations under a contract with the state Medicaid agency or a Medicaid managed care organization. DefinitionsThis measure defines "340B program" as the program created pursuant to the Veterans Health Care Act of 1992 and codified as section 340B of the federal Public HealthServices Act. This measure defines a "contract pharmacy" as a pharmacy that has executed a contract with a covered entity to dispense covered outpatient drugs, purchased by the covered entity through the 340B program, to eligible patients of the covered entity. This measure defines a "Medicaid managed care organization" as an entity acting pursuant to a contract with the department of health and human services to administer the medical assistance program. This measure defines a "similarly situated entity or pharmacy" as an entity or pharmacy located in Iowa that is of a generally comparable size, and that operates in a market with similar demographic characteristics, including population size, density, distribution, and vital statistics, and reasonably similar economic and geographic conditions. This measure takes effect July 1 if passed. 

This measure prohibits health insurance plans and pharmacy benefits managers from discriminating against 340B covered pharmacies in reimbursement pricing or any other contractual conditions, including fees, chargebacks, audits, etc not levied on similar non-covered pharmacies.

This measure makes changes related to third party payors and manufacturers participating in the 340B drug pricing program.Third party requirements: A third party is required to: (1) inform a patient that they are not required to use a mail-order pharmacy; (2) obtain a signed waiver from a patient before allowing the use of a mail-order pharmacy; (3) make drug formulary and coverage decisions based on the third party's normal course of business; (4) allow a patient to use any pharmacy or provider the patient chooses; and (5) eliminate contracts with discriminatory terms. Third party restrictions: A third party may not: (1) coerce or require a patient to use a mail-order pharmacy; (2) discriminate, lower the reimbursement, or impose separate terms upon a pharmacy in any other third party contract because a pharmacy participates in 340B drug pricing; (3) require a pharmacy to reverse, resubmit or clarify a 340B drug pricing claim after the initial adjudication, unless it is the normal course of pharmacy business and not related to 340B drug pricing; (4) require a billing modifier to indicate that the drug or claim is a 340B drug pricing; (5) modify a patient's copayment on the basis of a pharmacy's participation in 340B drug pricing; (6) exclude a pharmacy from a network on the basis of the pharmacy's participation in 340B drug pricing; (7) establish or set network adequacy requirements based on 340B drug pricing participation by a provider or a pharmacy; or (8) prohibit a covered entity or a pharmacy under contract with a covered entity from participating in the third party's provider network because of an entity's participation in 340B drug pricing.Pharmaceutical manufacturer restrictions: A pharmaceutical manufacturer may not: (1) prohibit a pharmacy from contracting or participating with a covered entity by denying access to drugs that are manufactured by the pharmaceutical manufacturer; or (2) deny or prohibit 340B drug pricing for a community pharmacy that receives drugs purchased under a 340B drug pricing contract pharmacy arrangement with a covered entity. This measure defines a "third party" as a payor that reimburses a pharmacy for drugs or services, including a pharmacy benefits manager. 

This measure prohibits practices by a health insurance issuer, pharmacy benefit manager, or other third-party payors that limits or imposes conditions that would indirectly lower the amount of reimbursement for a drug discounted according to the federal 340B drug pricing program that was dispensed by an entity participating in the 340B drug pricing program. This measure prohibits actions by a manufacturer or distributor that would deny, restrict, prohibit, or interfere with the acquisition of a 340B discounted drug to a pharmacy that is under contract with a healthcare facility that participates in the 340B drug discount program. This measure defines a 340B drug as a drug that has been subject to any offer for reduced prices by a manufacturer and is purchased by a covered entity. This measure defines a 340B entity as an entity participating or authorized to participate in the federal 340B drug discount program including its pharmacy or any pharmacy contracted with the participating entity to dispense drugs purchased through the 340B drug discount program.This measure takes effect August 1 after enacted. 

Effective Date: 10/1/22
This measure applies to pharmacy benefits managers. Under this measure, PBMs are required to make formulary decisions for a pharmacy or pharmacist that participates in the 340B program based on the normal course of business and allow a beneficiary to use any pharmacy or pharmacist that they choose without regard to 340B participation. PBMs are prohibited from: Transferring 340B program savings from a pharmacy or pharmacy that participates in the 340B programOffering lower reimbursement for a prescription drug purchased under the 340B programRefusing to cover prescription drugs covered under the 340B drug plan Refusing to allow pharmacies participating in the 340B program to participate in the PBM’s network Charging more than fair market value or seeking profit sharing in exchange for services for pharmacies participating in the 340B program. Require or otherwise limit a beneficiary to use a specified mail-order pharmacy that participates in the 340B program as a condition of coverage. Impose different contract terms on pharmacies that participate in a PBM’s network based on 340B participation Impose differed fees, chargebacks, or other adjustments on pharmacies or pharmacists based on 340B participation. Modify a beneficiary’s copayment based on a pharmacy’s 340B participation. Establish network adequacy requirements based on pharmacy 340B participation Prohibit an entity authorized to participate in the 340B program from participating in the PBM’s network PBMs are prohibited from basing formulary or prescription drug coverage decisions based on the price of the drug under the 340B program or whether the dispensing pharmacy participates in the 340B program. 340B claims processed by participating pharmacies are final at the point of adjudication. "Pharmacies or pharmacists that participate in the 340B program" means a pharmacy owned or operated by a covered entity eligible to or actively participating in the 340B program or a pharmacy/pharmacist under contract with a covered entity to dispense drugs purchased under the 340B program.This measure takes effect on October 1, 2022.

This measure prohibits discrimination against 340B drug discount program participants. This measure states that no drug coverage that reimburses a 340B covered entity or its contract pharmacy for drugs that are subject to an agreement must: Reimburse a covered entity or contract pharmacy for a quantity of a 340B drug in an amount less than such plan, issuer, or manager would pay to any other similarly situated entity or pharmacy that is not a covered entity or a contract pharmacy for such quantity of such drug on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B drugs. Discriminate against a 340B-covered entity or a contract pharmacy by imposing requirements, exclusions, reimbursement terms, or other conditions on such entity or pharmacy that differ from those applied to entities or pharmacies that are not 340B-covered entities or contract pharmacies on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B drugs. Require a claim for a drug to include a modifier to indicate that the drug is a 340B drug, or any other method of identifying the claim as 340B, unless the claim is for payment, directly or indirectly, by Medicaid. This measure states that no drug coverage that reimburses a 340B covered entity or its contract pharmacy for drugs that are subject to an agreement must impose any terms or conditions on 340B-covered entities or contract pharmacies with respect to any of the following that differ from such terms or conditions applied to other similarly situated entities or pharmacies that are not 340B-covered entities or contract pharmacies on the basis that the entity or pharmacy is a 340B-covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B drugs:Fees, chargebacks, clawbacks, adjustments, or other assessments.Professional dispensing fees.Restrictions or requirements regarding participation in standard or preferred pharmacy networks. Requirements relating to the frequency or scope of audits or to inventory management systems using generally accepted accounting principles. This measure states that no entity that makes payment for such drugs must discriminate against the 340B-covered entity or its contract pharmacy in a manner that prevents or interferes with a patient’s choice to receive such drugs from the 340B covered entity or its contract pharmacy. 

This measure states that no drug coverage that reimburses a 340B covered entity or its contract pharmacy for drugs that are subject to an agreement must: Reimburse a covered entity or contract pharmacy for a quantity of a 340B drug in an amount less than such plan, issuer, or manager would pay to any other similarly situated entity or pharmacy that is not a covered entity or a contract pharmacy for such quantity of such drug on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B drugs. Discriminate against a 340B-covered entity or a contract pharmacy by imposing requirements, exclusions, reimbursement terms, or other conditions on such entity or pharmacy that differ from those applied to entities or pharmacies that are not 340B-covered entities or contract pharmacies on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B drugs. Require a claim for a drug to include a modifier to indicate that the drug is a 340B drug, or any other method of identifying the claim as 340B, unless the claim is for payment, directly or indirectly, by Medicaid. This measure states that no drug coverage that reimburses a 340B covered entity or its contract pharmacy for drugs that are subject to an agreement must impose any terms or conditions on 340B-covered entities or contract pharmacies with respect to any of the following that differ from such terms or conditions applied to other similarly situated entities or pharmacies that are not 340B-covered entities or contract pharmacies on the basis that the entity or pharmacy is a 340B-covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B drugs: Fees, chargebacks, clawbacks, adjustments, or other assessments. Professional dispensing fees. Restrictions or requirements regarding participation in standard or preferred pharmacy networks. Requirements relating to the frequency or scope of audits or to inventory management systems using generally accepted accounting principles. This measure states that no entity that makes payment for such drugs must discriminate against the 340B-covered entity or its contract pharmacy in a manner that prevents or interferes with a patient’s choice to receive such drugs from the 340B covered entity or its contract pharmacy. 

This measure prohibits discrimination against covered 340B participating pharmacies by PBMs or insurers in price, network access, etc compared to a non-covered pharmacy offering similar services.It does not list an effective date.

This measure prohibits discrimination against covered 340B participating pharmacies by PBMs or insurers in price, network access, etc compared to a non-covered pharmacy offering similar services.

This measure amends statute relating to pharmacy benefit managers and 340B entity reimbursement. This measure provides that a PBM that reimburses a 340B entity for drugs may not reimburse the 340B entity for drugs at a rate lower than paid for the same drug to pharmacies similar in a prescription volume that are not 340B entities. 

This measure also prohibits a pharmacy or pharmacist from entering a contract with a pharmacy benefit manager that interferes with a patient’s choice to receive an eligible prescription drug from a 340B entity or a pharmacy when dispensing a 340B drug.

This measure states that a health carrier or pharmacy benefits manager must not discriminate against a covered entity or a specified pharmacy by doing any of the following: Reimbursing a covered entity or specified pharmacy for a quantity of a 340B drug in an amount less than such health carrier or pharmacy benefits manager would pay to any other similarly situated pharmacy that is not a covered entity or a specified pharmacy. Imposing any terms or conditions on covered entities or specified pharmacies that differ from such terms or conditions applied to other similarly situated pharmacies on the basis that are not covered entities or specified pharmacies on the basis that the entity of pharmacy is a covered entity or specified pharmacy of that the entity or pharmacy dispenses 340B drugs. Interfering with an individual's choice to receive a 340B drug from a covered entity or specified pharmacy (whether in person or via mail or delivery). Requiring a covered entity or specified pharmacy to identify (indirectly or directly through a third party) 340B drugs. Refusing to contract with a covered entity or specified pharmacy for reasons other than those that apply equally to entities or pharmacies that are not covered entities or specified pharmacies, or on the basis that the entity or pharmacy is a covered entity or a specified pharmacy. The provision regarding terms and conditions within this measure includes: Fees, chargebacks, clawbacks, adjustments, or other assessments.Professional dispensing fees.Restrictions or requirements regarding participation in standard or preferred pharmacy networks.Requirements relating to the frequency or scope of audits or to inventory management systems using generally accepted accounting principles. Any other restrictions, conditions, practices, or policies as specified by the director of the department of commerce and insurance, interfere with the ability of a covered entity to maximize the value of discounts provided. This measure states that the director of the department of commerce and insurance must provide rules to implement the provisions of this measure. This measure takes effect August 28, 2023 if passed.  

This measure provides that a pharmacy benefit manager or health carrier may not:(1) prohibit a federally certified health entity or a pharmacy under contract with an entity to provide pharmacy services from participating in the pharmacy benefit manager's or health carrier's provider network;(2) reimburse a federally certified health entity or a pharmacy under contract with an entity differently than it reimburses other similarly situated pharmacies;(3) require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program provided for in Title 53, chapter 6, part 20 1; or(4) create a restriction or an additional charge on a patient who chooses to receive drugs from a federally certified health entity or a pharmacy under contract with an entity, including but not limited to a patient's inability to fully pay a copayment. 

This measure prohibits PBMs and insurers from the following: Prohibiting federally certified health entities or pharmacies from participating in the insurer's network. Reimbursing a federally certified health entity or pharmacy differently than reimbursing other similarly situated pharmacies. Requiring a claim or a drug to include a modifier to indicate that the drug is a 340B drug, unless the claim is for Medicaid payment. Creating restrictions or imposing additional charges on patients who choose to receive drugs from a federally certified health entity or pharmacy.

Effective Date: 01/01/23
This measure provides that PBM that reimburses a 340B entity or 340B contract pharmacy is subject to an agreement under the U.S code on the limitation on prices of drugs purchased by covered entities and will not reimburse the 340 B entity or 340 B contract pharmacy for the pharmacy-dispensed drug at a rate lower than what was paid for the same drug to similarly situated pharmacies that are not 34B entities or 340B contract pharmacies.

This measure prohibits PBMs from discriminating against covered entities or contract pharmacies that participate in the 340B drug program. This measure prohibits PBMs and health carriers from: Discrimination against a covered entity that participates in the 340B program to purchase drugs at a discounted rate or a pharmacy that contracts with such an entity with regard to reimbursement. Assess any fee, chargeback, clawback, or adjustment against a covered entity or contract pharmacy on the basis that the covered entity or contract pharmacy participates in the 340B program. Restrict the ability of a person to receive a 340B drug. Restrict the methods in which a contract pharmacy or covered entity dispenses or delivers a 340B drug. Taking certain actions to limit the ability of such an entity or pharmacy to receive the full benefit of participating in that program. Excluding such an entity or pharmacy from an insurance network because the entity or pharmacy participates in the 340B program. Taking certain other actions to limit the participation of an entity or pharmacy in the program. This measure requires the program to take certain actions and refrain from certain activity to ensure that a covered provider that participates in the 340B program to purchase drugs at a discounted rate or a pharmacy that contracts with such a provider receives the full benefit of participating in the program. This measure prohibits the program administered by the Department from:Denying a request from such a covered provider or contract pharmacy to participate in the network of the program in certain circumstances. Engaging in certain discrimination against a covered provider or contract pharmacy. 

This measure prohibits PBMs from discriminating against 340B entities by:Reimbursing for a 340B drug at a lower rate. Assessing fees or chargebacks not assessed to non-covered entitiesImposing provisions preventing/interfering with a person's choice to receive a 340B covered drug Imposing any different terms or conditions including those affecting network participating, audits, claims adjudication, or pharmacy choice. This measure states that when calculating an enrollee's cost-sharing obligation for covered prescription drugs, the insurer must credit the enrollee for the full value of any discounts provided or payments made by third parties at the time of the prescription drug claim. 

Managed care providers and PBMs are required to reimburse 340B providers for outpatient drugs dispensed at the NADAC, or at the current benchmark under fee-for-service if the NADAC pricing is unavailable, plus a dispensing fee. Rates of payment between 340B entities and covered pharmacies that obtain and dispense 340B drugs must comprise a fee schedule based on fair market principles. In order to align managed care provider formularies, managed care providers and PBMs must be are required to use the fee-for-service preferred drug list when developing a formulary. 

Final Enacted: 4/21/21
This measure amends North Dakota Century Code relating to PBM discrimination against 340B entities. Prohibits PBMs from discriminating against 340B entities, or reimburse a lower dollar amount for a drug purchased under the 340B program. They must also not hold a pharmacy responsible for a fee for any step related to the claims adjudication processing network. 

This measure prohibits insurers offering policies or certificates of health insurance and pharmacy benefit managers from requiring claims for reimbursement of prescription drugs to include modifiers or another indicator that the drug is a 340B drug. 

Effective Date: 7/1/21
This measure creates Tennessee code to (1) prohibit payers from discriminating against a 340B entity, (2) regulate pharmacy benefit manager operations regarding specialty pharmacy and allowed amounts, and (3) require health covered entities to provide certain information about covered drugs and benefits to enrollees upon request.

340B Entities
This provision applies to health insurance issuers, managed health insurance issuers, pharmacy benefits managers, and other third-party payers ("payers").
This measure prohibits payer from:
1. Reimbursing a 340B entity for pharmacy-dispensed drugs at a rate lower than the rate paid for the same drug to non-340B entities;
2. Assessing a fee, chargeback, or adjustment upon a 340B entity that is not equally assessed on non-340B entities;
3. Excluding 340B entities from its network of participating pharmacies based on criteria that is not applied to non-340B entities; or
4. Requiring a claim for a drug by a national drug code number to include a modifier to identify that the drug is 340B drug.
This measure prohibits a payer from discriminating in any way against a 340B entity that interferes with the patient's choice to receive those drugs from the 340B entity.

Effective Date: 5/5/21
This measure creates Utah code to prohibit a pharmacy benefit manager from varying the amount that the insurer reimburses an FQHC based on drug or pharmacy participation in the 340B program. This measure applies to health insurers and federally qualified health centers (FQHC), which includes a contracted pharmacy or pharmacies to dispense drugs purchased through the FQHC. This measure prohibits an insurer from varying the amount that the insurer reimburses an FQHC on the basis of whether: (i) the drug is a 340B drug; or (ii) the pharmacy is a 340B entity. This does not apply to a drug reimbursed by the Medicaid program. This measure prohibits an insurer or an insurer's pharmacy service entity from, on the basis that a FQHC participates, directly or through a contractual arrangement, in the 340B drug discount program:

1. Assessing a fee, charge-back, or other adjustment on an FQHC;

2. Restricting access to the insurer's pharmacy network;

3. Requiring the FQHC to enter into a contract with a specific pharmacy to participate in the insurer's pharmacy network;

4. Creating a restriction or an additional charge on a patient who chooses to receive drugs from an FQHC; or

5. Creating any additional requirements or restrictions on the FQHC.

This measure further prohibits an insurer or its pharmacy service from requiring a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program. This measure does not outline any rule-making or enforcement mechanisms.

This measure states that a PBM or other third party that reimburses a 340B covered entity for drugs that are through the 340B drug pricing program must not reimburse the 340B covered entity for pharmacy-dispensed drugs at a rate lower than that paid for the same drug to pharmacies that are not 340B covered entities, and the PBM must not assess any fee, charge-back, or other adjustment on the 340B covered entity on the basis that the covered entity participates in the 340B program. This measure states that a PBM must not discriminate against a 340B covered entity in a manner that interferes with the patient's choice to receive drugs from the 340B covered entity. This measure states that a PBM must not: Require a claim for a drug to include a modifier or supplemental transmission, or both, to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by Medicaid. Restrict access to a pharmacy network or adjust reimbursement rates based on a pharmacy’s participation in a 340B contract pharmacy arrangement. 

Effective Date: 7/1/22
This measure provides that PBMs or other third parties that reimburse a 340B covered entity may not reimburse the 340B covered entity at a rate lower than that for non-340B covered entities. This measure provides that a PBM may not prevent or interfere with a patient's choice to receive drugs from a 340B covered entity. This measure will take effect on July 1, 2022.

This measure applies to pharmacy benefit managers and health insurance carriers.This measure will prohibit interference with a covered individual's right to choose a pharmacy or provider, based on the pharmacy or provider's status as a covered entity or contract pharmacy. The measure would prohibit the Imposition of requirements, exclusions, reimbursement terms, or other conditions on a covered entity or contract pharmacy that differ from those applied to entities or pharmacies that are not covered entities or contract pharmacies on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this section will apply to drugs with an annual estimated per-patient cost exceeding $250,000 or prohibit the identification of a 340B reimbursement request.The measure defines a "Contract pharmacy" as a pharmacy operating under contract with a 340B-covered entity to provide dispensing services to the 340B-covered entity. The measure defines a "Covered entity" as an entity described in § 340B(a)(4) of the federal Public Health Service Act, 42 U.S.C. § 256B(a)(4).This measure defines "Covered Entity" as an entity described in section 340B of the federal Public Health Service Act, this will not include a hospital. 

Effective Date: 6/10/22
This measure applies to pharmacy benefit managers. Under this measure, it is considered discriminatory practice for a PBM to place additional requirements or restrictions on 340B entities resulting in administrative costs or fees that are not placed on other pharmacies or requiring claims for drugs to include modifiers or resubmitted to indicate that the drug is a 340B drug.