SB0147sam002 95TH GENERAL ASSEMBLY

Sen. Deanna Demuzio

Filed: 3/22/2007

09500SB0147sam002 LRB095 04329 DRJ 34280 a

AMENDMENT TO SENATE BILL 147

AMENDMENT NO. ______. Amend Senate Bill 147, AS AMENDED, by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Patient Prescription Fulfillment Act.

Section 5. Definition. In this Act:

"Drug interchange" means a change from one prescription drug to another.

"Pharmacy benefit manager" means a third party administrator of a prescription drug program that is responsible for processing and paying prescription drug claims. The term includes, without limitation, insurers, self-insured entities, managed care organizations, and government programs.

Section 10. Patient prescription fulfillment.

(a) When a patient presents a prescription written by his or her physician for a brand-name drug to a pharmacy to be filled, the pharmacy shall give the patient a 30-day supply of the prescribed drug. The pharmacy shall charge the patient the lowest copayment amount for brand-name drugs according to the prescription drug formulary adopted by the patient's pharmacy benefit manager.

(b) Within 30 days after a prescription is filled in accordance with subsection (a), the patient's pharmacy benefit manager shall contact the patient's physician who wrote the prescription to inform the physician of the current prescription drug formulary choices available to the patient. The information provided by the pharmacy benefit manager must include the copayment amounts for the various drug choices, any material differences between alternative drug choices with respect to side effects and patient health and safety, the current prescribing information for those alternative drug choices approved by the federal Food and Drug Administration, and the current evidence-based research underlying the formulary committee's determination of therapeutic equivalence.

(c) Upon reviewing the information provided by a pharmacy benefit manager under subsection (b), a physician may either accept or reject a drug interchange proposed by the pharmacy benefit manager based on the alternative drug choices set forth in the prescription drug formulary.

(d) If a pharmacy benefit manager does not seek a drug interchange with respect to a patient's prescription order within 30 days after the prescription is filled in accordance with subsection (a), the pharmacy benefit manager may not impose a drug interchange and must treat the prescription as if written for a brand-name drug having the lowest copayment amount according to the pharmacy benefit manager's prescription drug formulary.

Section 15. Drug interchange.

(a) A pharmacy benefit manager may not impose a drug interchange without the express verifiable authorization of the patient's physician.

(b) A pharmacy benefit manager must reverse a drug interchange upon instructions from the prescribing physician or the patient unless the originally prescribed drug is not in the pharmacy benefit manager's prescription drug formulary or unless the patient is unwilling to pay the higher copayment for the originally prescribed drug.

(c) If a pharmacy demands from a patient any additional copayment for a prescription drug during the 30 days following the filling of a prescription in accordance with subsection (a) of Section 10 on account of a drug interchange, the patient's pharmacy benefit manager shall reimburse the patient for that additional amount for up to 6 months after the drug interchange.

Section 20. Records. A pharmacy benefit manager must maintain records of all physician contacts made under Section 10 and all physician authorizations for drug interchanges for a minimum of 2 years following the date of any such contact or authorization.

Section 99. Effective date. This Act takes effect upon becoming law.".