The General Assembly approved major prescription drug legislation in the waning hours of the 2018 legislative session.
HB 5384 is largely a mechanism for data collection about factors affecting prescription medicine pricing.
It also requires certain reporting about frequently prescribed drugs and rebates. The effective dates of the bill's provisions are staggered, with most not triggered until 2021.
The bill requires pharmacy benefit managers to report to the state insurance commissioner discounts, concessions, and other rebates that affect prescription drug prices paid to a PBM or health insurance carrier.
In turn, the state insurance commissioner must report annually to the legislature's Insurance and Real Estate Committee aggregated information reported by PBMs and carriers.
Carrier Reporting Requirements
Each carrier is required to report to the commissioner its 25:
- Most frequently prescribed medicines
- Most costly medicines
- Medicines with the greatest year-over-year cost increase
- Most frequently prescribed medicines for which it received manufacturer rebates
Carriers must also report:
- The portion of premiums attributed to brand name, generic, and specialty drugs, and the year-over-year increase in the total cost of these drugs, calculated on a per member, per month basis
- A comparison, calculated on a per member, per month basis, of the year-over-year increase in the cost of prescription medicines to the year-over-year increase in the costs of other plan premium components
- The names of covered special drugs
Rebates, Premium Calculations
HB 5384 charges the insurance commissioner with annual reporting, including:
- An explanation of how carriers accounted for rebates when calculating premiums
- A statement as to how carriers made rebates available to insureds
- Other information concerning how carriers applied rebates
HB 5384 gives the Office of Health Strategy three new tasks.
First, entities developing new medicines must report to OHS applications filed with the U.S. Food and Drug Administration.
Second, OHS may, with the assistance of the state comptroller and social services commissioner, study drugs in development or under FDA review that may have a significant impact on prescription drug expenditures.
Third, OHS together with the state comptroller, social services commissioner, and public health commissioner, must report on the 10 or more drugs critical to public health that are the costliest to the state.