HB 226: "An Act relating to the Board of Pharmacy; relating to insurance; relating to pharmacies; relating to pharmacists; relating to pharmacy benefits managers; relating to patient choice of pharmacy; and providing for an effective date."
00 HOUSE BILL NO. 226 01 "An Act relating to the Board of Pharmacy; relating to insurance; relating to 02 pharmacies; relating to pharmacists; relating to pharmacy benefits managers; relating 03 to patient choice of pharmacy; and providing for an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 08.80.030(b) is amended to read: 06 (b) In order to fulfill its responsibilities, the board has the powers necessary 07 for implementation and enforcement of this chapter, including the power to 08 (1) elect a president and secretary from its membership and adopt rules 09 for the conduct of its business; 10 (2) license by examination or by license transfer the applicants who are 11 qualified to engage in the practice of pharmacy; 12 (3) assist the department in inspections and investigations for 13 violations of this chapter, or of any other state or federal statute relating to the practice 14 of pharmacy;
01 (4) adopt regulations to carry out the purposes of this chapter; 02 (5) establish and enforce compliance with professional standards and 03 rules of conduct for pharmacists engaged in the practice of pharmacy; 04 (6) determine standards for recognition and approval of degree 05 programs of schools and colleges of pharmacy whose graduates shall be eligible for 06 licensure in this state, including the specification and enforcement of requirements for 07 practical training, including internships; 08 (7) establish for pharmacists and pharmacies minimum specifications 09 for the physical facilities, technical equipment, personnel, and procedures for the 10 storage, compounding, and dispensing of drugs or related devices, and for the 11 monitoring of drug therapy, including independent monitoring of drug therapy; 12 (8) enforce the provisions of this chapter relating to the conduct or 13 competence of pharmacists practicing in the state, and the suspension, revocation, or 14 restriction of licenses to engage in the practice of pharmacy; 15 (9) license and regulate the training, qualifications, and employment of 16 pharmacy interns and pharmacy technicians; 17 (10) license and regulate the qualifications of entities and individuals 18 engaged in the manufacture or distribution of drugs and related devices; 19 (11) establish and maintain a controlled substance prescription 20 database as provided in AS 17.30.200; 21 (12) establish standards for the independent prescribing and 22 administration of vaccines and related emergency medications under AS 08.80.168, 23 including the completion of an immunization training program approved by the board 24 and an epinephrine auto-injector training program under AS 17.22.020(b); 25 (13) establish standards for the independent prescribing and dispensing 26 by a pharmacist of an opioid overdose drug under AS 17.20.085, including the 27 completion of an opioid overdose training program approved by the board; 28 (14) require that a licensed pharmacist who dispenses a schedule II, III, 29 or IV controlled substance under federal law to a person in the state register with the 30 controlled substance prescription database under AS 17.30.200(n); 31 (15) establish the qualifications and duties of the executive
01 administrator and delegate authority to the executive administrator that is necessary to 02 conduct board business; 03 (16) license and inspect the facilities of pharmacies, manufacturers, 04 wholesale drug distributors, third-party logistics providers, and outsourcing facilities 05 located outside the state under AS 08.80.159; 06 (17) license Internet-based pharmacies providing services to residents 07 in the state; 08 (18) adopt regulations pertaining to retired pharmacist status; 09 (19) for a prescription drug that the United States Food and Drug 10 Administration or the prescription drug's manufacturer has not approved for 11 self-administration, prohibit, limit, or provide conditions relating to the 12 dispensing of the prescription drug, including establishing specifications to 13 ensure the effectiveness and security of a prescription drug to be administered by 14 infusion or otherwise administered in a clinical setting. 15 * Sec. 2. AS 21.27.901 is amended by adding a new subsection to read: 16 (c) Each day that a pharmacy benefits manager conducts business in the state 17 as a pharmacy benefits manager without being registered as required by (a) of this 18 section is a separate violation of this section. 19 * Sec. 3. AS 21.27.945(a) is amended to read: 20 (a) A pharmacy benefits manager shall 21 (1) provide [MAKE AVAILABLE] to each network pharmacy at the 22 beginning of the term of the network pharmacy's contract, and upon renewal of the 23 contract, the methodology and sources used to determine the [DRUG PRICING] list; 24 (2) provide the list to a network pharmacy without charge; 25 (3) [(2)] provide and keep current a telephone number at which a 26 network pharmacy may contact an employee of a pharmacy benefits manager [TO 27 DISCUSS THE PHARMACY'S APPEAL]; 28 (4) [(3)] provide a process for a network pharmacy to have ready 29 access to the list specific to that pharmacy; 30 (5) [(4)] review and update [APPLICABLE] list information at least 31 once every seven [BUSINESS] days to ensure [REFLECT MODIFICATION OF] list
01 pricing reflects current national drug database pricing; 02 (6) [(5)] update list prices within one business day after a significant 03 price update or modification provided by the pharmacy benefits manager's national 04 drug database provider; and 05 (7) [(6)] ensure that dispensing fees are not included in the calculation 06 of the list pricing. 07 * Sec. 4. AS 21.27.945(b) is repealed and reenacted to read: 08 (b) Before placing or maintaining a specific drug on the list, a pharmacy 09 benefits manager shall ensure that 10 (1) if the drug is therapeutically equivalent and pharmaceutically 11 equivalent to a prescribed drug, the drug is listed as therapeutically equivalent and 12 pharmaceutically equivalent "A" or "B" rated in the most recent edition or supplement 13 of the United States Food and Drug Administration's Approved Drug Products with 14 Therapeutic Equivalence Evaluations, also known as the Orange Book; 15 (2) if the drug is a different biological product than a prescribed drug, 16 the drug is an interchangeable biological product; 17 (3) the drug is readily available for purchase by each pharmacy in the 18 state from national or regional wholesalers operating in the state; and 19 (4) the drug is not obsolete or temporarily unavailable. 20 * Sec. 5. AS 21.27.945 is amended by adding new subsections to read: 21 (c) The list a pharmacy benefits manager provides to a network pharmacy 22 under (a) of this section must 23 (1) be maintained in a searchable electronic format that is accessible 24 with a computer; 25 (2) identify each drug for which a reimbursement amount is 26 established; and 27 (3) specify for each drug 28 (A) the national drug code; 29 (B) the national average drug acquisition cost, if available; 30 (C) the wholesale acquisition cost, if available; and 31 (D) the reimbursement amount.
01 (d) In this section, 02 (1) "interchangeable biological product" has the meaning given in 03 AS 08.80.480; 04 (2) "pharmaceutically equivalent" means a drug has identical amounts 05 of the same active chemical ingredients in the same dosage form and meets the 06 standards of strength, quality, and purity according to the United States Pharmacopeia 07 published by the United States Pharmacopeial Convention or another similar 08 nationally recognized publication; 09 (3) "significant price update or modification" means 10 (A) an increase of 10 percent or more in the pharmacy 11 acquisition cost from 60 percent or more of the pharmaceutical wholesalers 12 doing business in the state; 13 (B) a change in the methodology in which the maximum 14 allowable cost for a drug is determined; or 15 (C) a change in the value of a variable involved in the 16 methodology used to determine the maximum allowable cost for a drug; 17 (4) "therapeutically equivalent" means a drug is from the same 18 therapeutic class as another drug and, when administered in an appropriate amount, 19 provides the same therapeutic effect as, and is identical in duration and intensity to, 20 the other drug; 21 (5) "therapeutic class" means a group of similar drug products that 22 have the same or similar mechanisms of action and are used to treat a specific 23 condition. 24 * Sec. 6. AS 21.27.950 is repealed and reenacted to read: 25 Sec. 21.27.950. Reimbursement. (a) A pharmacy benefits manager shall 26 reimburse a pharmacy or pharmacist for a drug in an amount not less than the national 27 average drug acquisition cost for the drug on the date that the drug is administered or 28 dispensed. If the national average drug acquisition cost is not available at the time a 29 drug is administered or dispensed, a pharmacy benefits manager shall reimburse in an 30 amount that is not less than the wholesale acquisition cost of the drug. If the wholesale 31 acquisition cost of the drug is not available at the time a drug is administered or
01 dispensed, a pharmacy benefits manager shall reimburse in an amount that is not less 02 than the pharmacy acquisition cost of the drug. 03 (b) In addition to the reimbursement required under (a) of this section, a 04 pharmacy benefits manager shall reimburse the pharmacy or pharmacist for a 05 professional dispensing fee that is not less than the pharmacy dispensing fee 06 applicable to providers in the state as listed in the Alaska Medicaid Fee Schedules and 07 Covered Codes provided by the Department of Health on the date that the drug is 08 administered or dispensed. 09 * Sec. 7. AS 21.27 is amended by adding new sections to read: 10 Sec. 21.27.951. Patient choice of pharmacy. (a) An insurer providing a 11 covered person with a health care insurance plan and its pharmacy benefits manager 12 may not 13 (1) prohibit or limit the person receiving pharmacy services under the 14 insurer's health care insurance plan, including mail-order and specialty pharmacy 15 services, from selecting a pharmacy of the person's choice to provide the pharmacy 16 services if the pharmacy has notified the insurer, or the pharmacy benefits manager 17 authorized to act on the insurer's behalf, of the pharmacy's agreement to accept as 18 payment in full reimbursement for the pharmacy's services at rates applicable to 19 pharmacies that are administered by the insurer or its pharmacy benefits manager, 20 including any copayment required by the insurer's health care insurance plan; or 21 (2) restrict access to drugs by limiting distribution of a drug through an 22 affiliate, except to the extent necessary to meet limited distribution requirements of the 23 United States Food and Drug Administration or to ensure the appropriate dispensing 24 of a drug that requires extraordinary special handling, provider coordination, or patient 25 education when those requirements cannot be met by a network pharmacy; an insurer 26 or its pharmacy benefits manager who restricts drug access or limits drug distribution 27 under the exceptions allowed by this paragraph shall, upon request, promptly provide 28 a pharmacy or pharmacist with a complete written description of all extraordinary 29 special handling, provider coordination, and patient education requirements necessary 30 for the distribution or dispensing of a drug; in this paragraph, "affiliate" means a 31 business, pharmacy, pharmacist, or provider who, directly or indirectly through one or
01 more intermediaries, controls, is controlled by, or is under common control with a 02 pharmacy benefits manager. 03 (b) An insurer providing a covered person with a health care insurance plan 04 and its pharmacy benefits manager shall permit a pharmacy or pharmacist to enter into 05 a direct service agreement or network pharmacy agreement with the insurer or its 06 pharmacy benefits manager if the pharmacy or pharmacist 07 (1) meets the terms and conditions of participation in the direct service 08 agreement or network pharmacy agreement; 09 (2) agrees to provide pharmacy services, including drugs, that meet the 10 terms and conditions required under the insurer's health care insurance plan, including 11 the terms of reimbursement; and 12 (3) not later than 30 days after being requested in writing to do so by 13 the insurer or its pharmacy benefits manager, executes and delivers to the insurer or its 14 pharmacy benefits manager the direct service agreement or network pharmacy 15 agreement that the insurer or its pharmacy benefits manager requires of all its network 16 pharmacies. 17 (c) An insurer or its pharmacy benefits manager shall act on a pharmacy's or 18 pharmacist's request for a direct service agreement or a network pharmacy agreement 19 not later than 30 days after the insurer or its pharmacy benefits manager receives the 20 pharmacy's or pharmacist's request or, if the insurer or its pharmacy benefits manager 21 requests supplemental information, 30 days after the insurer or its pharmacy benefits 22 manager receives the supplemental information. 23 (d) A network pharmacy or a pharmacy applying to become a network 24 pharmacy under this section shall be presumed to meet the requirements of a specialty 25 pharmacy upon its assertion that it meets the requirements of a specialty pharmacy. 26 (e) In this section, 27 (1) "specialty drug" means a drug that is subject to restricted 28 distribution by the United States Food and Drug Administration; 29 (2) "specialty pharmacy" means a pharmacy capable of meeting the 30 requirements of the United States Food and Drug Administration applicable to 31 specialty drugs.
01 Sec. 21.27.952. Patient access to clinician-administered drugs. (a) An 02 insurer or its pharmacy benefits manager may not 03 (1) refuse to authorize, approve, or pay a provider for providing 04 covered clinician-administered drugs and related services to a covered person if the 05 provider has agreed to participate in the insurer's health care insurance plan according 06 to the terms offered by the insurer or its pharmacy benefits manager; 07 (2) if the criteria for medical necessity is met, condition, deny, restrict, 08 refuse to authorize or approve, or reduce payment to a provider for a clinician- 09 administered drug because the provider obtained the clinician-administered drug from 10 a pharmacy that is not a network pharmacy in the insurer's or its pharmacy benefits 11 manager's network; 12 (3) impose coverage or benefit limitations or require a covered person 13 to pay an additional fee, a higher or additional copay or coinsurance, or a penalty 14 when obtaining a clinician-administered drug from a network pharmacy authorized 15 under the laws of this state to dispense or administer the drug; 16 (4) require a covered person to pay an additional fee, a higher or 17 additional copay or coinsurance, or another form of a price increase for a clinician- 18 administered drug when the drug is not dispensed by a pharmacy or acquired from an 19 entity selected by the insurer or its pharmacy benefits manager; 20 (5) interfere with the right of a covered person to obtain a clinician- 21 administered drug from the provider or pharmacy of the person's choice, including by 22 inducement, steering, or offering or promoting financial or other incentives; 23 (6) limit or exclude coverage for a clinician-administered drug when 24 not dispensed by a pharmacy or acquired from an entity selected by the insurer or its 25 pharmacy benefits manager when the drug would otherwise be covered; 26 (7) require a pharmacy to dispense a clinician-administered drug 27 directly to a covered person or agent of the insured with the intention that the covered 28 person or the agent of the insured will transport the medication to a provider for 29 administration; 30 (8) require or encourage the dispensing of a clinician-administered 31 drug to a covered person in a manner that is inconsistent with the supply chain security
01 controls and chain of distribution set by 21 U.S.C. 360eee - 360eee-4 (Drug Supply 02 Chain Security Act); 03 (9) require that a clinician-administered drug be dispensed or 04 administered to a covered person in the residence of the covered person or require use 05 of an infusion site external to the office, department, or clinic of the provider of the 06 covered person; nothing in this paragraph prohibits the insurer or its pharmacy 07 benefits manager, or an agent of the insurer or its pharmacy benefits manager, from 08 offering the use of a home infusion pharmacy or external infusion site. 09 (b) In this section, "clinician-administered drug" means a drug, other than a 10 vaccine, that requires administration by a provider and that the United States Food and 11 Drug Administration or the drug's manufacturer has not approved for self- 12 administration. 13 Sec. 21.27.953. Penalties. In addition to any other penalty provided by law, if 14 a person violates AS 21.27.945 - 21.27.955, the director may, after notice and hearing, 15 impose a penalty in accordance with AS 21.27.440. 16 * Sec. 8. AS 21.27.955(4) is amended to read: 17 (4) "list" means a [THE] list of [MULTI-SOURCE GENERIC] drugs 18 for which a pharmacy benefits manager has established predetermined 19 reimbursement amounts, or methods for determining reimbursement amounts, to 20 be paid to a network pharmacy or pharmacist for pharmacy services, [AMOUNT 21 HAS BEEN ESTABLISHED] such as a maximum allowable cost or maximum 22 allowable cost list or any other list of prices used by a pharmacy benefits manager; 23 * Sec. 9. AS 21.27.955(6) is repealed and reenacted to read: 24 (6) "network pharmacy" means a pharmacy or pharmacist who, under 25 a contract or agreement with the insurer or its pharmacy benefits manager, has agreed 26 to provide pharmacy services to a covered person with an expectation of receiving 27 payment, other than in-network coinsurance, copayments, or deductibles, directly or 28 indirectly from the insurer; 29 * Sec. 10. AS 21.27.955 is amended by adding new paragraphs to read: 30 (11) "covered person" means an individual receiving medication 31 coverage or reimbursement provided by an insurer or its pharmacy benefits manager
01 under a health care insurance plan; 02 (12) "drug" means a prescription drug; 03 (13) "health care insurance plan" has the meaning given in 04 AS 21.54.500; 05 (14) "insurer" has the meaning given in AS 21.97.900 and includes a 06 company or group of companies under common management, ownership, or control; 07 (15) "maximum allowable cost" means the maximum amount that a 08 pharmacy benefits manager will reimburse a pharmacy for the cost of a drug; 09 (16) "national average drug acquisition cost" means the average 10 acquisition cost for outpatient drugs covered by Medicaid, as determined by a monthly 11 survey of retail pharmacies conducted by the federal Centers for Medicare and 12 Medicaid Services; 13 (17) "network" means an entity that, through contracts or agreements 14 with providers, provides or arranges for access by groups of covered persons to health 15 care services by providers who are not otherwise or individually contracted directly 16 with an insurer or its pharmacy benefits manager; 17 (18) "provider" means a physician, pharmacist, hospital, clinic, 18 hospital outpatient department, pharmacy under the common ownership or control of a 19 provider, or other person licensed or otherwise authorized in this state to furnish health 20 care services; 21 (19) "wholesale acquisition cost" has the meaning given in 42 U.S.C. 22 1395w-3a(c)(6)(B). 23 * Sec. 11. AS 21.36 is amended by adding a new section to read: 24 Sec. 21.36.126. Unfair trade practices. (a) An insurer providing a health care 25 insurance plan or its pharmacy benefits manager may not 26 (1) violate AS 21.27.950; 27 (2) interfere with a covered person's right to choose a pharmacy or 28 provider as provided in AS 21.27.951; 29 (3) interfere with a covered person's right of access to a clinician- 30 administered drug as provided in AS 21.27.952; 31 (4) interfere with the right of a pharmacy or pharmacist to participate
01 as a network pharmacy as provided in AS 21.27.951; 02 (5) reimburse a pharmacy or pharmacist an amount less than the 03 amount the pharmacy benefits manager reimburses an affiliate for providing the same 04 pharmacy services, calculated on a per-unit basis using the same generic product 05 identifier or generic code number; 06 (6) impose a copayment, fee, or condition that is not equally imposed 07 on all individuals in the same benefit category, class, or copayment level, whether or 08 not the benefits are furnished by a pharmacy or pharmacist who is not a network 09 pharmacy; 10 (7) steer, invite, or direct a patient to use an affiliate's services through 11 verbal or written communication, including 12 (A) online messaging regarding the affiliate; or 13 (B) patient- or prospective patient-specific advertising, 14 marketing, or promotion of the affiliate; 15 (8) impose any monetary advantage, inducement, or penalty that could 16 affect or influence a person's choice among pharmacies that have agreed to participate 17 in the plan according to the terms offered by the insurer or its pharmacy benefits 18 manager, including a higher or additional copayment or fee or promotion of one 19 participating pharmacy over another; 20 (9) impose a reduction in reimbursement for pharmacy services 21 because of the person's choice among pharmacies that have agreed to participate in the 22 plan according to the terms offered by the insurer or its pharmacy benefits manager; 23 (10) use a covered person's pharmacy services data collected under the 24 provision of claims processing services for the purpose of soliciting, marketing, or 25 referring the person to an affiliate of the pharmacy benefits manager; 26 (11) require a covered person, as a condition of payment or 27 reimbursement, to purchase pharmacist services or products, including drugs, through 28 a mail-order pharmacy or pharmacy benefits manager affiliate; 29 (12) prohibit or limit a network pharmacy from mailing, shipping, or 30 delivering drugs to a patient as an ancillary service; however, the insurer or its 31 pharmacy benefits manager
01 (A) is not required to reimburse a delivery fee charged by a 02 pharmacy unless the fee is specified in the contract between the pharmacy 03 benefits manager and the pharmacy; 04 (B) may not require a patient signature as proof of delivery of a 05 mailed or shipped drug if the network pharmacy 06 (i) maintains a mailing or shipping log signed by a 07 representative of the pharmacy or keeps a record of each notification of 08 delivery provided by the United States mail or a package delivery 09 service; and 10 (ii) is responsible for the cost of mailing, shipping, or 11 delivering a replacement for a drug that was mailed or shipped but not 12 received by the covered person; 13 (13) impose on a pharmacist or pharmacy seeking to remain or become 14 a network provider credentialing standards that are more strict than the licensing 15 standards set by the Board of Pharmacy or charge a pharmacy a fee in connection with 16 network enrollment; 17 (14) prohibit or limit a network pharmacy from informing an insured 18 person of the difference between the out-of-pocket cost to the covered person to 19 purchase a drug, medical device, or supply using the covered person's pharmacy 20 benefits and the pharmacy's usual and customary charge for the drug, medical device, 21 or supply; 22 (15) conduct or participate in spread pricing in the state; 23 (16) assess, charge, or collect a form of remuneration that passes from 24 a pharmacy or a pharmacist in a pharmacy network to the pharmacy benefits manager 25 including claim processing fees, performance-based fees, network participation fees, 26 or accreditation fees. 27 (b) A provision of a contract between a pharmacy benefits manager and a 28 pharmacy or pharmacist that is contrary to a requirement of this section is null, void, 29 and unenforceable in this state. 30 (c) A violation of this section or a regulation adopted under this section is an 31 unfair trade practice and subject to penalty under this chapter.
01 (d) For purposes of this section, a violation has occurred each time a 02 prohibited act is committed. 03 (e) Nothing in this section may interfere with or violate a patient's right under 04 AS 08.80.297 to know where the patient may have access to the lowest cost drugs or 05 the requirement that a patient must receive notice of a change to a pharmacy network, 06 including the addition of a new pharmacy or removal of an existing pharmacy from a 07 pharmacy network. 08 (f) In this section, 09 (1) "affiliate" has the meaning given in AS 21.27.951(a)(2); 10 (2) "clinician-administered drug" has the meaning given in 11 AS 21.27.952(b); 12 (3) "covered person" has the meaning given in AS 21.27.955; 13 (4) "drug" has the meaning given in AS 21.27.955; 14 (5) "health care insurance plan" has the meaning given in 15 AS 21.54.500; 16 (6) "insurer" has the meaning given in AS 21.27.955; 17 (7) "mail-order pharmacy" means a pharmacy whose primary business 18 is to receive drugs by mail or through electronic submission and to dispense 19 medication to a covered person through the use of the United States mail or other 20 common or contract carrier services and that may provide consultation with a covered 21 person electronically rather than face-to-face; 22 (8) "network pharmacy" has the meaning given in AS 21.27.955; 23 (9) "out-of-pocket cost" means a deductible, coinsurance, copayment, 24 or similar expense owed by a covered person under the terms of the covered person's 25 health care insurance plan; 26 (10) "provider" has the meaning given in AS 21.27.955; 27 (11) "spread pricing" means the method of pricing a drug in which the 28 contracted price for a drug that a pharmacy benefits manager charges a health care 29 insurance plan differs from the amount the pharmacy benefits manager directly or 30 indirectly pays the pharmacist or pharmacy for pharmacist services. 31 * Sec. 12. AS 29.10.200 is amended by adding a new paragraph to read:
01 (68) AS 29.20.420 (health care insurance plans). 02 * Sec. 13. AS 29.20 is amended by adding a new section to article 5 to read: 03 Sec. 29.20.420. Health care insurance plans. (a) If a municipality offers a 04 group health care insurance plan covering municipal employees, including by means 05 of self-insurance, the municipal health care insurance plan, including the 06 administration and management of pharmacy benefits under the plan, is subject to the 07 requirements of AS 21.27.901 - 21.27.955 and AS 21.36.126. 08 (b) This section applies to home rule and general law municipalities. 09 (c) In this section, "health care insurance plan" has the meaning given in 10 AS 21.54.500. 11 * Sec. 14. AS 39.30.090(a) is amended to read: 12 (a) The Department of Administration may obtain a policy or policies of group 13 insurance covering state employees, persons entitled to coverage under AS 14.25.168, 14 14.25.480, AS 22.25.090, AS 39.35.535, 39.35.880, or former AS 39.37.145, 15 employees of other participating governmental units, or persons entitled to coverage 16 under AS 23.15.136, subject to the following conditions: 17 (1) a group insurance policy shall provide one or more of the following 18 benefits: life insurance, accidental death and dismemberment insurance, weekly 19 indemnity insurance, hospital expense insurance, surgical expense insurance, dental 20 expense insurance, audiovisual insurance, or other medical care insurance; 21 (2) each eligible employee of the state, the spouse and the unmarried 22 children chiefly dependent on the eligible employee for support, and each eligible 23 employee of another participating governmental unit shall be covered by the group 24 policy, unless exempt under regulations adopted by the commissioner of 25 administration; 26 (3) a governmental unit may participate under a group policy if 27 (A) its governing body adopts a resolution authorizing 28 participation and payment of required premiums; 29 (B) a certified copy of the resolution is filed with the 30 Department of Administration; and 31 (C) the commissioner of administration approves the
01 participation in writing; 02 (4) in procuring a policy of group health or group life insurance as 03 provided under this section or excess loss insurance as provided in AS 39.30.091, the 04 Department of Administration shall comply with the dual choice requirements of 05 AS 21.86.310, and shall obtain the insurance policy from an insurer authorized to 06 transact business in the state under AS 21.09, a hospital or medical service corporation 07 authorized to transact business in this state under AS 21.87, or a health maintenance 08 organization authorized to operate in this state under AS 21.86; an excess loss 09 insurance policy may be obtained from a life or health insurer authorized to transact 10 business in this state under AS 21.09 or from a hospital or medical service corporation 11 authorized to transact business in this state under AS 21.87; 12 (5) the Department of Administration shall make available bid 13 specifications for desired insurance benefits or for administration of benefit claims and 14 payments to (A) all insurance carriers authorized to transact business in this state 15 under AS 21.09 and all hospital or medical service corporations authorized to transact 16 business under AS 21.87 who are qualified to provide the desired benefits; and (B) 17 insurance carriers authorized to transact business in this state under AS 21.09, hospital 18 or medical service corporations authorized to transact business under AS 21.87, and 19 third-party administrators licensed to transact business in this state and qualified to 20 provide administrative services; the specifications shall be made available at least once 21 every five years; the lowest responsible bid submitted by an insurance carrier, hospital 22 or medical service corporation, or third-party administrator with adequate servicing 23 facilities shall govern selection of a carrier, hospital or medical service corporation, or 24 third-party administrator under this section or the selection of an insurance carrier or a 25 hospital or medical service corporation to provide excess loss insurance as provided in 26 AS 39.30.091; 27 (6) if the aggregate of dividends payable under the group insurance 28 policy exceeds the governmental unit's share of the premium, the excess shall be 29 applied by the governmental unit for the sole benefit of the employees; 30 (7) a person receiving benefits under AS 14.25.110, AS 22.25, 31 AS 39.35, or former AS 39.37 may continue the life insurance coverage that was in
01 effect under this section at the time of termination of employment with the state or 02 participating governmental unit; 03 (8) a person electing to have insurance under (7) of this subsection 04 shall pay the cost of this insurance; 05 (9) for each permanent part-time employee electing coverage under 06 this section, the state shall contribute one-half the state contribution rate for permanent 07 full-time state employees, and the permanent part-time employee shall contribute the 08 other one-half; 09 (10) a person receiving benefits under AS 14.25, AS 22.25, AS 39.35, 10 or former AS 39.37 may obtain auditory, visual, and dental insurance for that person 11 and eligible dependents under this section; the level of coverage for persons over 65 12 shall be the same as that available before reaching age 65 except that the benefits 13 payable shall be supplemental to any benefits provided under the federal old age, 14 survivors, and disability insurance program; a person electing to have insurance under 15 this paragraph shall pay the cost of the insurance; the commissioner of administration 16 shall adopt regulations implementing this paragraph; 17 (11) a person receiving benefits under AS 14.25, AS 22.25, AS 39.35, 18 or former AS 39.37 may obtain long-term care insurance for that person and eligible 19 dependents under this section; a person who elects insurance under this paragraph 20 shall pay the cost of the insurance premium; the commissioner of administration shall 21 adopt regulations to implement this paragraph; 22 (12) each licensee holding a current operating agreement for a vending 23 facility under AS 23.15.010 - 23.15.210 shall be covered by the group policy that 24 applies to governmental units other than the state; 25 (13) a group health insurance policy covering employees of a 26 participating governmental unit must meet the requirements of AS 21.27.901 - 27 21.27.955 and AS 21.36.126, including requirements relating to administration 28 and management of pharmacy benefits under the policy. 29 * Sec. 15. AS 39.30.091 is amended to read: 30 Sec. 39.30.091. Authorization for self-insurance and excess loss insurance. 31 Notwithstanding AS 21.86.310 or AS 39.30.090, the Department of Administration
01 may provide, by means of self-insurance, one or more of the benefits listed in 02 AS 39.30.090(a)(1) for state employees eligible for the benefits by law or under a 03 collective bargaining agreement and for persons receiving benefits under AS 14.25, 04 AS 22.25, AS 39.35, or former AS 39.37, and their dependents. The department shall 05 procure any necessary excess loss insurance under AS 39.30.090. A self-insured 06 group medical plan covering active state employees provided under this section is 07 subject to the requirements of AS 21.27.901 - 21.27.955 and AS 21.36.126, 08 including requirements relating to administration and management of pharmacy 09 benefits under the plan. 10 * Sec. 16. AS 45.50.471(b) is amended by adding a new paragraph to read: 11 (58) violating AS 21.36.126(a) (insurers and pharmacy benefits 12 managers), if the violation is committed or performed with a frequency that indicates a 13 general business practice. 14 * Sec. 17. AS 21.27.901(b)(3), 21.27.901(b)(4), and 21.27.955(5) are repealed. 15 * Sec. 18. The uncodified law of the State of Alaska is amended by adding a new section to 16 read: 17 APPLICABILITY. This Act applies to a contract between a pharmacy benefits 18 manager and a pharmacy or pharmacist entered into, renewed, or amended on or after the 19 effective date of this Act. 20 * Sec. 19. This Act takes effect July 1, 2024.