05/15/2025 03:15 PM House HEALTH & SOCIAL SERVICES

        SB 134-PHARMACY BENEFITS MANAGER;3RD PARTY ADMIN                                                                    
                                                                                                                                
4:23:14 PM                                                                                                                    
                                                                                                                                
CHAIR MINA  announced that the  first order of business  would be                                                               
SENATE  BILL  NO. 134,  "An  Act  relating to  pharmacy  benefits                                                               
managers; relating  to third-party administrators;  and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
4:23:42 PM                                                                                                                    
                                                                                                                                
JANE   ROHR,  Staff,   Senator   Cathy   Giessel,  Alaska   State                                                               
Legislature,  presented  SB 134  on  behalf  of Senator  Giessel,                                                               
prime sponsor.   She  stated that  pharmacy benefit  managers and                                                               
third-party   administrators   do  business   as   intermediaries                                                               
"between insurance companies and  pharmacies or consumers."  Some                                                               
responsibilities  include the  negotiation  of medication  prices                                                               
and the processing of claims.  She continued:                                                                                   
                                                                                                                                
     Current   statute  requires   these   entities  to   be                                                                    
     registered,  which only  allows  for a  basic level  of                                                                    
     recognition.   The purpose of  this bill is  to require                                                                    
     transparency   and   accountability   for   third-party                                                                    
     administrators and pharmacy  benefit managers operating                                                                    
     in  the  state  of  Alaska, by  requiring  them  to  be                                                                    
     licensed and  subject to oversight  by the  Division of                                                                    
     Insurance.                                                                                                                 
                                                                                                                                
MS. ROHR, in conclusion, offered to answered questions.                                                                         
                                                                                                                                
4:24:31 PM                                                                                                                    
                                                                                                                                
CHAIR MINA  noted those available  for questions  and entertained                                                               
amendments.                                                                                                                     
                                                                                                                                
4:24:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  moved to adopt  Amendment 1 to  SB 134,                                                               
labeled 34-LS0461\A.2, Wallace, 5/14/25, which read as follows:                                                                 
                                                                                                                                
     Page 16, following line 13:                                                                                                
          Insert a new bill section to read:                                                                                    
        "* Sec. 32. AS 21.36.520(a) is amended to read:                                                                     
          (a)  An insurer providing a health care insurance                                                                     
     policy or its pharmacy benefits manager may not                                                                            
               (1)  interfere with a covered person's right                                                                     
     to choose a pharmacy or provider;                                                                                          
               (2)  interfere with a covered person's right                                                                     
     of access to a clinician-administered drug;                                                                                
               (3)  interfere with the right of a pharmacy                                                                      
     or pharmacist to participate as a network pharmacy;                                                                        
               (4)  reimburse a pharmacy or pharmacist an                                                                       
     amount  less  than  the amount  the  pharmacy  benefits                                                                    
     manager reimburses an affiliate  for providing the same                                                                    
     pharmacy  services,  calculated  on  a  per-unit  basis                                                                    
     using the  same generic  product identifier  or generic                                                                    
     code number;                                                                                                               
               (5)  impose a  reduction in reimbursement for                                                                    
     pharmacy services because of  the person's choice among                                                                    
     pharmacies that have agreed to  participate in the plan                                                                    
     according to  the terms offered  by the insurer  or its                                                                    
     pharmacy benefits manager;                                                                                                 
               (6)     use   a  covered   person's  pharmacy                                                                    
     services data  collected under the provision  of claims                                                                    
     processing  services  for  the purpose  of  soliciting,                                                                    
     marketing, or  referring the person to  an affiliate of                                                                    
     the pharmacy benefits manager;                                                                                             
               (7)    prohibit  or  limit  a  pharmacy  from                                                                    
     mailing, shipping, or delivering  drugs to a patient as                                                                    
     an  ancillary  service;  however, the  insurer  or  its                                                                    
     pharmacy benefits manager                                                                                                  
               (A)  is not required  to reimburse a delivery                                                                    
     fee charged by  a pharmacy unless the  fee is specified                                                                    
     in the  contract between the pharmacy  benefits manager                                                                    
     and the pharmacy;                                                                                                          
               (B)   may not require a  patient signature as                                                                    
     proof of  delivery of a  mailed or shipped drug  if the                                                                    
     pharmacy                                                                                                                   
               (i)   maintains  a  mailing  or shipping  log                                                                    
     signed by a  representative of the pharmacy  or keeps a                                                                    
     record  of each  notification of  delivery provided  by                                                                    
     the United  States mail or a  package delivery service;                                                                    
     and                                                                                                                        
               (ii)     is  responsible  for  the   cost  of                                                                    
     mailing, shipping,  or delivering  a replacement  for a                                                                    
     drug that  was mailed  or shipped  but not  received by                                                                    
     the covered person;                                                                                                        
               (8)   prohibit  or limit  a network  pharmacy                                                                    
     from  informing an  insured  person  of the  difference                                                                    
     between the  out-of-pocket cost  to the  covered person                                                                    
     to  purchase a  drug, medical  device, or  supply using                                                                    
     the   covered  person's   pharmacy  benefits   and  the                                                                    
     pharmacy's  usual and  customary charge  for the  drug,                                                                    
     medical device, or supply;                                                                                                 
               (9)     conduct  or  participate   in  spread                                                                    
     pricing in the state;                                                                                                      
               (10)   assess, charge,  or collect a  form of                                                                    
     remuneration  that   passes  from   a  pharmacy   or  a                                                                    
     pharmacist  in  a  pharmacy  network  to  the  pharmacy                                                                    
     benefits  manager,  including  claim  processing  fees,                                                                    
     performance-based fees, network  participation fees, or                                                                    
     accreditation fees;                                                                                                        
               (11)   reverse  and resubmit  the claim  of a                                                                    
     pharmacy more  than 90  days after  the date  the claim                                                                    
         was first adjudicated, and may not reverse and                                                                         
     resubmit the claim of a pharmacy unless the insurer or                                                                     
     pharmacy benefits manager                                                                                                  
               (A)  provides prior written notification to                                                                      
     the pharmacy;                                                                                                              
               (B)  has just cause;                                                                                             
               (C)  first attempts to reconcile the claim                                                                       
     with the pharmacy; and                                                                                                     
               (D)  provides to the pharmacy, at the time                                                                       
     of the reversal and resubmittal, a written description                                                                     
       that includes details of and justification for the                                                                       
     reversal and resubmittal;                                                                                              
               (12)  prohibit or limit a pharmacy from                                                                      
      collecting a fee from a covered person for a service                                                                  
     or product not covered by the covered person's health                                                                  
     care insurance policy."                                                                                                
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
CHAIR MINA objected for the purpose of discussion.                                                                              
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  explained that there have  been reports                                                               
of contracts or policies that do  not allow a pharmacy to collect                                                               
a  fee for  additional services,  such as  delivery or  adherence                                                               
packing, without  risking termination of contract.   The language                                                               
that would be added by adopting Amendment 1 would remedy that.                                                                  
                                                                                                                                
CHAIR MINA removed her objection.                                                                                               
                                                                                                                                
4:26:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GRAY objected.  He asked who would pay.                                                                          
                                                                                                                                
REPRESENTATIVE RUFFRIDGE clarified that  Amendment 1 allows for a                                                               
service that  is not  already covered  under the  plan; therefore                                                               
the fee would be charged to  the patient.  In response to follow-                                                               
up questions  from Representative Gray,  Representative Ruffridge                                                               
noted that he, as a  pharmacist, regularly mails prescriptions to                                                               
patients in  remote areas or  when items are difficult  to obtain                                                               
from different locations.  He  noted that Amendment 1 would allow                                                               
a pharmacy to offer delivery service.                                                                                           
                                                                                                                                
4:28:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRAY  removed  his  objection.   There  being  no                                                               
further objection, Amendment 1 was adopted.                                                                                     
                                                                                                                                
4:29:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GRAY  moved to report  SB 134, as amended,  out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being no  objection,  HCSSB 134(HSS)  was                                                               
reported out  of the  House Health  and Social  Services Standing                                                               
Committee.