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(a) A health insurance policy or government program providing benefits for prescriptions shall not impose on a covered individual utilizing a retail pharmacy a copayment, deductible, fee, limitation on benefits or other condition or requirement not otherwise imposed on the covered individual when using a mail-order pharmacy.
(b) Subsection (a) shall apply only if the retail pharmacy is willing to accept from the insurer the same pricing, terms, conditions or requirements related to the cost of the prescriptions and the cost and quality of dispensing prescriptions that the insurer has established for a mail-order pharmacy and any of such pharmacy's affiliates, including any affiliated pharmacy benefit manager, pursuant to the health insurance policy.
(c) Beginning eighteen months after the effective date of this section, the Legislative Budget and Finance Committee shall conduct an evaluation of the impact of this section regarding the access to prescription drugs at both independent and chain retail pharmacies and whether the provisions of this section have had a material positive or negative impact upon the cost of prescription medications to consumers and health care plans and shall issue a report to the General Assembly within nine months of the commencement of the study regarding its findings and recommendations.
(d) As used in this section:
(1) “Government program” means any of the following:
(i) The Commonwealth's medical assistance program established under the act of June 13, 1967 (P.L. 31, No. 21), 1 known as the “Public Welfare Code.”
(ii) The Children's Health Care Program established under Article XXIII. 2
(iii) The program of pharmaceutical assistance for the elderly established under Chapter 5 of the act of August 26, 1971 (P.L. 351, No. 91), 3 known as the “State Lottery Law.”
(2) “Health insurance policy” means a group or individual health or sickness or accident insurance policy, subscriber contract or certificate issued by an entity subject to any one of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L. 1701, No. 364), 4 known as the “Health Maintenance Organization Act.”
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).
The term does not include accident only, fixed indemnity, limited benefit, credit, dental, vision, specified disease, Medicare supplement, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement, long-term care or disability income, workers' compensation or automobile medical payment insurance.
(3) “Insurer” means any entity that issues a group or individual health, sickness or accident policy or subscriber contract described under paragraph (2).
(4) “Mail-order pharmacy” means a pharmacy as defined in the act of September 27, 1961 (P.L. 1700, No. 699), 5 known as the “Pharmacy Act,” where prescriptions are dispensed to covered individuals via the mail.
(5) “Prescription” and “dispensing” mean those terms as defined in the act of September 27, 1961 (P.L. 1700, No. 699), known as the “Pharmacy Act.”
(6) “Retail pharmacy” means a pharmacy as defined in the act of September 27, 1961 (P.L. 1700, No. 699), known as the “Pharmacy Act,” where prescriptions are able to be dispensed to covered individuals on the premises of such pharmacy.
Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 764l. Coverage of prescriptions - last updated January 01, 2019 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-764l/
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