THE GENERAL ASSEMBLY OF
PENNSYLVANIA
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No.
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INTRODUCED BY DeLUCA, PICKETT, FRANKEL, D. COSTA,
PASHINSKI, MILLARD, COX, DONATUCCI, CALTAGIRONE, GODSHALL, WATSON, FABRIZIO,
McNEILL, KORTZ, DALEY, PYLE, THOMAS, MATZIE, SOLOMON AND STURLA, JANUARY 23, 2017
AN ACT
Amending the act of May 17, 1921 (P.L.682,
No.284), entitled "An act relating to insurance;
amending, revising, and consolidating the law providing for
the incorporation of insurance companies, and the regulation,
supervision, and protection of home and foreign insurance
companies, Lloyds associations, reciprocal and inter-insurance
exchanges, and fire insurance rating bureaus, and the regulation
and supervision of insurance carried by such companies, associations, and exchanges, including insurance carried by the State Workmen's Insurance Fund; providing penalties; and repealing existing laws," in casualty insurance, providing for pharmaceutical cost transparency.
Section 1.
The act of May 17, 1921 (P.L.682, No.284), known as The
Insurance Company Law of 1921, is amended by adding a section
to read:
(3)
An average wholesale price that has increased by fifty per centum (50%) or more over the past five years.
(4)
An average wholesale price that has increased by twenty-five per centum (25%) or more over the past twelve months.
(b)
A health insurance policy or government program providing
benefits for a prescription drug described under subsection
(a) may not be required to provide the benefits if the
Insurance Department finds that the manufacturer of the prescription
drug has not filed a report on the prescription drug as
required under subsection (c).
(c) On
or before March 1 of each year, a manufacturer of a prescription
drug described under subsection (a) shall file with the
Insurance Department the following information on a form prescribed
by the Insurance Department:
(i) The
research and development costs paid by the manufacturer,
and separately, the research and development costs paid by any
predecessor in the development of the drug.
(ii)
The costs of clinical trials and other regulatory costs paid by the manufacturer, and separately, the costs of clinical trials and other regulatory costs paid by any predecessor in the development of the
(iv)
The costs paid by any entity other than the manufacturer
or predecessor for research and development, including, but
not limited to, any amount from Federal, State or other
governmental programs or any form of subsidies, grants or other
support.
(v) The
other costs to acquire the drug, including costs for the
purchase of patents, licensing or acquisition of a corporate entity
owning rights to the drug while in development, or all of the
costs under this subparagraph.
(vi)
The marketing and advertising costs for the promotion of the drug directly to consumers, including, but not limited to:
(A)
Costs associated with coupons or discounts, that are directed to consumers and the amount redeemed.
(B)
Marketing and advertising costs for promotion of the drug directly or indirectly to prescribers.
(D)
Any payments or contributions to providers not employed on a full-time basis by the manufacturer, regardless of whether the payments or contributions are connected to a particular drug.
(2)
The filing under this subsection must be audited and certified by an independent third-party auditor prior to filing.
(3) A
cumulative annual history of average wholesale price increases for the drug expressed
as percentages, including the months each average wholesale
price increase took effect.
(4) The
profit attributable to the drug as represented in dollars
and represented as a percentage of the total company profits
that were derived from the sale of the drug.
(5) A
description of the manufacturers' patient prescription assistance
programs, including, but not limited to:
(iii)
The average amount of assistance per resident of this Commonwealth and for which drugs the assistance was provided.
(6)
Any payments or financial incentives, direct or indirect,
to hospitals, health care providers or physicians attributable
to the drug described under subsection
(a), including, but not
limited to, speaking fees, dinners, research, consulting,
charitable donations, grants or other incentives.
(c) The
Insurance Department may promulgate regulations as may
be necessary and appropriate to carry out the provisions of this
section.
(1) For
a health insurance policy for which either rates or forms
are required to be filed with the Federal Government or the
Insurance Department, this section shall apply to any policy for
which a form or rate is first permitted to be used on or after
180 days following the effective date of this section.
(2) For
a health insurance policy for which neither rates nor
forms are required to be filed with the Federal Government or
the Insurance Department, this section shall apply to any policy
issued or renewed on or after 180 days following the effective
date of this section.
(i) The
Commonwealth's medical assistance program established
under the act of June 13, 1967 (P.L.31, No.21), known as the
Human Services Code.
(ii)
The program for comprehensive health care for uninsured children established under Article XXIII-A.
(iii)
The program of pharmaceutical assistance for the elderly established under Chapter 5 of the act of August 26, 1971 (P.L.351, No.91), known as the State Lottery Law.
(2)
"Health insurance policy" means a policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage. The term does not include any
of the following:
(vi) A
TRICARE policy, including a Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement policy.
(3)
"Insurer" means an entity licensed by the Insurance
Department with accident and health authority to issue a policy,
subscriber contract, certificate or plan that provides medical
or health care coverage that is offered or governed under any of
the following:
(ii)
The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act.
(iii)
40 Pa.C.S. Ch. 61 (relating to hospital plan corporations)
or 63 (relating to professional health services plan
corporations).
(4)
"Prescription" means a written or oral order issued by a
duly licensed medical practitioner in the course of the practitioner's professional practice for a controlled substance, other drug or device or medication that is dispensed for use by a consumer.
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