HF58 Summary

• Manufacturers must report prescription drug prices annually (beginning March 31, 2022) for drugs costing $100 or more per 30-day supply, including wholesale acquisition cost, average wholesale price, and drug identifiers to the Commissioner of Health.

• Manufacturers cannot increase wholesale acquisition costs for drugs included in health plan formularies during the next calendar year following price reporting; violations subject to civil penalties up to $10,000 per day and disciplinary action.

• Health plan companies must file formularies with the Commissioner of Commerce, disclose formulary and benefit information to enrollees at least 30 days before annual renewal, and organize disclosures according to USP Model Guidelines.

• Health plan companies are restricted from removing brand name drugs from formularies or increasing enrollee costs except when therapeutically equivalent or interchangeable generic/biologic alternatives are added, and must provide 60-day notice to affected parties.

• Group purchasers and pharmacy benefit managers must implement real-time prescription benefit tools complying with NCPDP standards to notify prescribers about drug coverage, formulary status, patient cost-sharing, prior authorization requirements, and alternative drug options.