Summary of Original Version

Create new sections of Subtitle 17A of KRS Chapter 304 to define terms for pharmacy-related insurance practices; require insurers, pharmacy benefit managers, and other pharmacy benefits administrators to establish reasonably adequate and accessible pharmacy networks; require the filing of an annual report; require the insurance commissioner to review pharmacy networks; provide that information and data acquired by the Department of Insurance shall be considered proprietary and not subject to disclosure under KRS 61.870 to 61.884 relating to open records; establish requirements for certain contracts between a pharmacy or pharmacist and an insurer, a pharmacy benefit manager, or any other pharmacy benefits administrator; establish prohibited conduct and requirements for certain pharmacy-related insurance practices; establish a complaint process for insureds, pharmacies, and pharmacists impacted by a violation of certain pharmacy-related insurance laws; create a new section of Subtitle 99 of KRS Chapter 304 to authorize the insurance commissioner to order reimbursement to persons who incurred a monetary loss as a result of a violation of certain pharmacy-related insurance laws; amend KRS 304.9-053 to require certain filings; amend KRS 304.9-054 to establish requirements for pharmacy benefit manager licensure; amend KRS 304.9-055 to permit the insurance commissioner to promulgate administrative regulations relating to pharmacy benefit managers; amend KRS 304.14-120 to require the insurance commissioner to review certain health plans; amend KRS 304.17A-712 to conform; amend KRS 304.17C-125 to apply certain pharmacy-related insurance laws to limited health service benefit plans, including limited health service contracts; amend KRS 304.38A-115 to apply certain pharmacy-related insurance laws to limited health service organizations; create a new section of KRS Chapter 18A to require the state employee health plan and state agencies to comply with certain pharmacy-related insurance laws; amend KRS 367.828 to establish certain requirements for health discount plans relating to prescription drugs; make technical corrections; repeal KRS 304.38A-120, relating to assignment of certain benefits under limited health service organization plans, to consolidate provisions; apply various sections to contracts issued or renewed on or after January 1, 2025; require the insurance commissioner to promulgate administrative regulations to implement this Act on or before January 1, 2025; EFFECTIVE, in part, January 1, 2025.

Summary of Amendment: Senate Committee Substitute 1

Summary Retain original provisions, except exempt Medicare Part D plans and student health insurance from the definition of "health plan"; define "ambulatory pharmacy"; amend minimum dispensing fee requirements; require the insurance commissioner to make a determination based on a study conducted every two years; delete prohibition against requiring or incentivizing the use of a mail-order pharmacy to furnish prescription drugs for subsequent administration in a hospital, clinic, pharmacy, or infusion center; amend requirements for the insurance commissioner's review of health plans; create a new section of KRS Chapter 315 to require reporting by ambulatory pharmacies to the Kentucky Board of Pharmacy; establish requirements for the collection, use, and sharing of data; require the Department of Insurance and the Kentucky Board of Pharmacy to consult, share data, and promulgate administrative regulations; require administrative regulations to be promulgated by certain dates.

Summary of Amendment: Senate Floor Amendment 1 -- M. Wise

Summary Delete 30 minutes distance standard as a network adequacy threshold; amend minimum dispensing fee requirement to exempt mail-order pharmaceutical distributors; delete and reinsert, as an amendment to KRS 18A.2254, application of pharmacy trade practice requirements to state employee health plan; make conforming amendments.

Statutes affected:
Introduced: 367.828
Acts Chapter 104: 18A.2254, 367.828, 315.191
Senate Committee Substitute 1: 367.828, 315.191
Current/Final: 18A.2254, 367.828, 315.191
Current: 18A.2254, 367.828, 315.191