This bill focuses on protecting rural independent pharmacies and expanding options for delivering and dispensing prescription medications. Here are the key provisions:
Courier and Delivery Services:
The bill prevents a pharmacy benefit manager (PBM) from blocking a rural independent pharmacy from using private couriers or delivery services to deliver prescription drugs to patients. This provision aims to give rural pharmacies more flexibility in serving their communities.
Reimbursement for Prescription Drugs:
A PBM is required to reimburse a rural independent pharmacy at no less than the average acquisition cost for similar prescription drugs, as determined by the medical services board within the Department of Health Care Policy and Financing.
In addition to the acquisition cost, the PBM must pay a dispensing fee to the pharmacy.
PBM Audits and Recoupment:
When a PBM conducts an audit and the results lead to a recoupment of funds or a penalty greater than $1,000, the PBM must notify the rural independent pharmacy at least 30 days in advance and inform them of their appeal rights before any funds are recouped.
Flex Pharmacy Definition:
The bill defines a flex pharmacy as a type of prescription drug outlet that:
Is registered with the State Board of Pharmacy.
Operates as a telepharmacy when the licensed pharmacist is not present.
Has a licensed pharmacist on-site for at least twice the number of hours the pharmacy operates as a telepharmacy.
Operates from the same location as the registered pharmacy.
Is a rural independent pharmacy.
The Board of Pharmacy is empowered to adopt rules to help facilitate the operation of flex pharmacies and may charge a fee for prescription drug outlets seeking to become flex pharmacies.
This bill addresses challenges faced by rural independent pharmacies, particularly those related to prescription drug delivery, reimbursement rates, and audit processes. It also introduces the concept of flex pharmacies to improve access to medications in rural areas by allowing telepharmacy operations.
Summary
The bill prevents a pharmacy benefit manager (PBM) from
prohibiting a rural independent pharmacy from using a private courier or a delivery service to deliver a prescription drug to a patient.
A PBM is required to reimburse a rural independent pharmacy for
a prescription drug in an amount not less than the average acquisition cost for like prescription drugs, as determined by the medical services board in the state department of health care policy and financing, plus pay a dispensing fee.
When a PBM conducts an audit of a rural independent pharmacy
and the audit results in a recoupment of more than $1,000 or a penalty of more than $1,000, the PBM must serve process on the rural independent pharmacy and notify the rural independent pharmacy of the rural independent pharmacy's appeal rights at least 30 days before any recoupment of funds.
The bill defines flex pharmacy as a prescription drug outlet that: •
Is registered with the state board of pharmacy (board) as a prescription drug outlet;
•
Operates as a telepharmacy during times when the licensed pharmacist is not on the premises;
•
Has a licensed pharmacist on the premises for at least twice the number of hours that the flex pharmacy operates as a telepharmacy;
•
Operates as a telepharmacy from the same premises as the premises where the pharmacy is registered; and
•
Is a rural independent pharmacy.
The board may adopt rules to facilitate the operation of flex
pharmacies and may assess a fee on a prescription drug outlet applying to be a flex pharmacy.
