(Doc Name H:\LEGWORK\HOUSE\AMEND\H-WM\010\PHARM SUB.DOCX):
EXPLANATION: Require MCOs and/or PBMs to provide claim-level pharmace reimbursement detail to the department
Amend the bill, as and if amended, Part IB, Section 33,
DEPARTMENT OF HEALTH & HUMAN SERVICES, page 353, after line
14, by adding an appropriately numbered paragraph to read:
/(DHHS: Pharmacy With the funds appropriated and
authorized to the Department of Health and Human Services in the
current fiscal year, the department shall require that any
managed care organization (MCO) or pharmacy benefit manager
(PBM) provide claim-level pharmacy reimbursement detail to both
the department and participating pharmacy providers reflecting
the amount paid to a PBM by the MCO and the amount paid by a PBM
on the MCO's behalf to a pharmacy provider to ensure
transparency and fiscal integrity of the state Medicaid program.
A pharmacy provider may only receive claim-level pharmacy
reimbursement details for prescriptions dispensed at that
provider's location. The department is authorized to make such
state plan, policy, or contract amendments as necessary to
implement these provisions./
Renumber sections to conform.
Amend totals and titles to conform.