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State of South Dakota
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NINETY-FOURTH SESSION LEGISLATIVE ASSEMBLY, 2019 |
| 846B0596 | HOUSE HEALTH AND HUMAN SERVICES ENGROSSED NO. HB 1137 - 2/7/2019 |
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Introduced by: Representatives Gosch, Anderson, Jensen (Kevin), Lake, and Peterson (Kent)
and Senators Steinhauer, Bolin, Rusch, Smith (VJ), and Solano
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FOR AN ACT ENTITLED, An Act to revise certain provisions regarding pharmacy benefit
managers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That chapter 58-29E be amended by adding a NEW SECTION to read:
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That chapter 58-29E be amended by adding a NEW SECTION to read:
No pharmacy benefit manager shall contractually require a pharmacy, who is a participating
provider in a health plan provided by a covered entity, to charge or collect from an insured a cost
share for a prescription or pharmacy service that exceeds the amount retained by the pharmacist
or pharmacy from all payment sources for the filling of the prescription or providing the
pharmacy service.
Section 2. That chapter 58-29E be amended by adding a NEW SECTION to read:
Section 2. That chapter 58-29E be amended by adding a NEW SECTION to read:
No pharmacy benefit manager contracting with a covered entity shall retroactively adjust a
claim for reimbursement submitted by a pharmacy for a prescription drug unless the adjustment
is a result of either of the following:
(1) A pharmacy audit conducted in accordance with chapter 58-29F; or
(2) A technical billing error.
Section 3. That chapter 58-29E be amended by adding a NEW SECTION to read:
Section 3. That chapter 58-29E be amended by adding a NEW SECTION to read:
Nothing in this Act shall prohibit a pharmacy benefit manager from adjusting claim payment
for the benefit of a covered individual if there was an error in the adjudication of a claim
submitted by or on behalf of the covered individual.
Section 4. That chapter 58-29E be amended by adding a NEW SECTION to read:
Section 4. That chapter 58-29E be amended by adding a NEW SECTION to read:
No pharmacy benefit manager may discriminate against a pharmacy participating in a health
plan as an entity authorized to participate under section 340B of the Public Health Service Act,
as amended to January 1, 2019, or any pharmacy under contract with such an entity to provide
prescriptions. For the purposes of this chapter, a retail pharmacy is any pharmacy licensed under
the laws of this state, and no pharmacy benefit manager may, by contract, modify that definition.
