An Act prohibiting PBMs from discriminating against hospitals and patients participating in the 340B drug discount program
Generates a plain-language summary of the bill text and history.
| Committee | Recommendation | Vote |
|---|---|---|
| J11 | Accompanied | — |
| Bill | Title | Status |
|---|---|---|
| H4494 | An Act prohibiting PBMs from discriminating against hospitals and patients participating in the 340B drug discount program | Active |
An Act prohibiting PBMs from discriminating against hospitals and patients participating in the 340B drug discount program. (a) In this section “340B covered entity” means an entity participating in the federal 340B drug discount program, as described in 42 U.S.C. § 256b, including its pharmacy or pharmacies, or any pharmacy or pharmacies, contracted with the participating entity to dispense drugs purchased through such program. (b) A pharmacy benefit manager or other third party that reimburses a 340B covered entity for drugs shall not: (1) reimburse the 340B covered entity for a drug at a rate lower than that paid for the same drug to entities that are not 340B covered entities; (2) 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; (3) restrict participation in a pharmacy or provider network based on an entity’s status as a 340B covered entity; (4) require the 340B covered entity to enter into a contract with a specific pharmacy to participate in the pharmacy benefit manager or third party’s pharmacy or provider network; (5) require a claim for a drug to include a modifier, supplemental transmission, to indicate that the drug is a 340B drug, or any other method of identifying the claim for a 340B drug, unless the claim is for payment, directly or indirectly, by Medicaid; or (6) impose coverage or benefits limitations, or require an enrollee to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining a drug from a 340 covered entity; (7) interfere with the patient's right to choose to obtain a drug from a 340B covered entity, including inducement, steering, or offering financial or other incentives.
An Act prohibiting PBMs from discriminating against hospitals and patients participating in the 340B drug discount program. (a) In this section “340B covered entity” means an entity participating in the federal 340B drug discount program, as described in 42 U.S.C. § 256b, including its pharmacy or pharmacies, or any pharmacy or pharmacies, contracted with the participating entity to dispense drugs purchased through such program. (b) A pharmacy benefit manager or other third party that reimburses a 340B covered entity for drugs shall not: (1) reimburse the 340B covered entity for a drug at a rate lower than that paid for the same drug to entities that are not 340B covered entities; (2) 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; (3) restrict participation in a pharmacy or provider network based on an entity’s status as a 340B covered entity; (4) require the 340B covered entity to enter into a contract with a specific pharmacy to participate in the pharmacy benefit manager or third party’s pharmacy or provider network; (5) require a claim for a drug to include a modifier, supplemental transmission, to indicate that the drug is a 340B drug, or any other method of identifying the claim for a 340B drug, unless the claim is for payment, directly or indirectly, by Medicaid; or (6) impose coverage or benefits limitations, or require an enrollee to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining a drug from a 340 covered entity; (7) interfere with the patient's right to choose to obtain a drug from a 340B covered entity, including inducement, steering, or offering financial or other incentives.