2018-S AMH CONW H2873.1

SHB 2018 - H AMD TO H AMD (H-2836.2/97) 349 FAILED 3-18-97

By Representative Conway

    On page 49, after line 37 of the amendment, insert the following:

    "NEW SECTION. Sec. 401.  The legislature intends that health care insurers have open pharmacy networks.  Insurers must offer contractual agreements to all pharmacies willing to meet applicable terms and conditions of the policy contract.  Insurers may not impose upon a beneficiary a copay, deductible, coinsurance, or prescription quantity limit that is not imposed upon all beneficiaries in the plan.  Pharmacy services are known to be a necessary component in the overall health care system.  Therefore, the legislature intends to promote access to ensure the citizens of Washington state can easily obtain their pharmacy services.

NEW SECTION. Sec. 402.  Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 1998, that provides for payment of all or a portion of prescription costs, or reimbursement of prescription costs, must:

    (1) Not limit the purchase of prescription medicines to specific pharmacies;

    (2) Not discriminate between different providers of pharmacy services by requiring the payment of different copayments, coinsurance levels, deductibles, or prescription quantity limits by the covered pharmacy patient depending on the identity or nature of the provider of pharmacy services;

    (3) Not prohibit a qualified provider of pharmacy services from becoming a provider under the policy if the applicant pharmacy indicates a desire to be recognized as a provider and meets all the applicable terms and conditions of the policy contract; and

    (4) Offer a provider of pharmacy services the same terms and conditions.

NEW SECTION. Sec. 403.  Section 402 of this act does not apply to:

    (1) A provider of pharmacy services if that provider cannot or will not meet all of the applicable terms and conditions of the policy contract; or

    (2) A health maintenance organization that provides pharmaceutical services through pharmacists it employs at pharmacies it owns.  A health maintenance organization is exempt in geographic areas in which it owns the pharmacy or pharmacies, but is not exempt in other geographic areas in which the health maintenance organization does not provide pharmacy services through its own pharmacy and employees.

NEW SECTION. Sec. 404.  (1) A health carrier, as defined in this chapter, who violates section 402 of this act or a rule adopted under that section may be subject to a penalty of not less than one thousand dollars nor more than fifty thousand dollars for each violation, payable to the health services account.

    (2) A person may bring action against a carrier to recover damages suffered as the result of a violation of section 402 of this act or a rule adopted under that section.  Proof of a violation constitutes prima facie evidence of damages.

NEW SECTION. Sec. 405.  Sections 402 through 404 of this act are each added to chapter 48.43 RCW."

    Renumber the remaining sections consecutively and correct internal references accordingly.

EFFECT:  Effective January 1, 1998, requires that every health plan that includes drug coverage must:

    Not limit the purchase of drugs to specific pharmacies;

    Not discriminate between different providers of pharmacy services by requiring the payment of different copayments, coinsurance levels, deductibles, or prescription quantity limits by the covered pharmacy patient depending on the identity or nature of the provider of pharmacy services;

    Not prohibit a qualified provider of pharmacy services from becoming a provider under the policy if the applicant pharmacy indicates a desire to be recognized as a provider and meets all the applicable terms and conditions of the policy contract; and

    Offer a provider of pharmacy services the same terms and conditions.

    Provisions do not apply to a provider of pharmacy services if that provider cannot or will not meet all of the applicable terms and conditions of the policy contract; or a health maintenance organization that provides pharmaceutical services through pharmacists it employs at pharmacies it owns.  A health maintenance organization is exempt in geographic areas in which it owns the pharmacy or pharmacies, but is not exempt in other geographic areas in which the health maintenance organization does not provide pharmacy services through its own pharmacy and employees.

    A carrier that violates may be subject to a penalty of not less than $1,000 or more than $50,000 for each violation, payable to the health services account.

    A person may bring action against a carrier to recover damages suffered as the result of a violation of these provisions.  Proof of a violation constitutes prima facie evidence of damages.

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