2020 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: Hodges
Co-Patron(s): Adams-L.
Medicaid Managed Care PBM Reimbursement for 340B Drugs (language only)

Item 313 #54h

Item 313 #54h

Health and Human Resources
Department of Medical Assistance Services


Page 321, after line 18, insert:

"GGGG.  The Department of Medical Assistance Services shall modify its managed care contracts to ensure that any pharmacy benefit manager, or any other third party, that reimburses a 340B entity for drugs that are subject to an agreement under 42 U.S.C. § 256b shall not reimburse the 340B entity for pharmacy-dispensed drugs at a rate lower than that paid for the same drug to pharmacies similar in prescription volume that are not 340B entities, and shall not request 340B cost information, nor assess any fee, charge-back, or other adjustment upon the 340B entity on the basis that the 340B entity participates in the program set forth in 42 U.S.C. § 256b.

With respect to a patient eligible to receive drugs subject to an agreement under 42 U.S.C. § 256b, a pharmacy benefit manager, or any other third party that makes payment for such drugs, shall not discriminate against a 340B entity in a manner that prevents or interferes with the patient's choice to receive such drugs from the 340B entity: Provided, that for purposes of this section, "third party" does not include the state Medicaid program when Medicaid is providing reimbursement for covered outpatient drugs, as that term is defined in 42 U.S.C. § 1396r-8(k), on a fee-for-service basis, provided, however, that "third party" does include a Medicaid-managed care organization as described in 42U.S.C. § 1396b(m).

This section does not apply with respect to claims under an employee benefit plan under the Employee Retirement Income Security Act of 1974 or, except for paragraph (d), to Medicare Part D.


(This amendment adds language restricting discriminatory actions of a pharmacy benefit manager or any other third party that makes payment to a 340B entity and interference with patient choice for such drugs provided through the 340B program. The 340B Program enables covered entities to stretch scarce federal and state resources as far as possible, reaching more eligible patients and providing more comprehensive services. Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices. Eligible health care organizations/covered entities are defined in statute and include federal Health Resources and Services Administration-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers.)