COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 573
(By Senators Bowman and Snyder)
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[Originating in the Committee on Government Organization;
reported March 25, 2009.]
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A BILL to amend and reenact §5A-3C-8 of the Code of West Virginia,
1931, as amended, relating to continuing the West Virginia
Pharmaceutical Cost Management Council as an advisory council
to the Pharmaceutical Advocate.
Be it enacted by the Legislature of West Virginia:
That §5A-3C-8 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 3C. PHARMACEUTICAL AVAILABILITY AND AFFORDABILITY ACT OF
2004.
§5A-3C-8. West Virginia Pharmaceutical Cost Management Council.
(a)
There is hereby created The West Virginia Pharmaceutical
Cost Management Council
which consists of is continued as an
advisory council to the Pharmaceutical Advocate with the following
eleven members:
(1) The Secretary of the Department of Administration or his or her designee;
(2) The Director of the Public Employees Insurance Agency or
his or her designee;
(3) The Commissioner of the Bureau for Medical Services of the
Department of Health and Human Resources or his or her designee;
(
4) The Secretary of the Department of Health and Human
Resources or his or her designee;
the Executive Director of the
Workers' Compensation Commission or his or her designee,
(5) The Bureau of Senior Services or his or her designee; and
(6) five Six members from the public who shall be appointed by
the Governor, with the advice and consent of the Senate,
as
follows:(A) One public member shall be a licensed pharmacist
employed by a community retail pharmacy;
(B) One public member shall be a representative of a
pharmaceutical manufacturer with substantial operations located in
the State of West Virginia that has at least seven hundred fifty
employees;
(C) One public member shall be a primary care physician;
(D) One public member shall represent those who will receive
benefit from the establishment of this program;
and
(
E) One public member shall have experience in the financing,
development or management of a health insurance company which
provides pharmaceutical coverage;
and
(F) One citizen member.
(b) Each public member shall serve for a term of four years.
Of the public members of the council first appointed, one shall be appointed for a term ending the thirtieth day of June, two thousand
six, and two each for terms of three and four years. Each public
member shall serve until his or her successor is appointed and has
qualified. A member of the council may be removed by the Governor
for cause.
(b) (c) The Secretary of the Department of Administration
shall serve as chairperson of the council, which shall meet at
times and places specified by the chairperson or upon the request
of two members of the council
: Provided, That the Pharmaceutical
Advocate cannot serve as chairperson.
(c) (d) Authority members shall not be compensated in their
capacity as members but shall be reimbursed for reasonable expenses
incurred in the performance of their duties.
(d) (e) The council has the power and authority to:
(1) Contract for the purpose of implementing the cost
containment provisions of this article;
(2) File suit;
(3) Execute, as permitted by applicable federal law,
prescription drug purchasing agreements with:
(A) All departments, agencies, authorities, institutions,
programs, any agencies or programs of the federal government,
quasi-public corporations and political subdivisions of this state,
including, but not limited to, the Children's Health Insurance
Program, the Division of Corrections, the Division of Juvenile
Services, the Regional Jail and Correctional Facility Authority,
the Workers' Compensation Fund, state colleges and universities, public hospitals, state or local institutions, such as nursing
homes, veterans' homes, the Division of Rehabilitation, public
health departments, state programs, including, but not limited to,
programs established in sections four and five of this article, and
the Bureau for Medical Services:
Provided, That any contract or
agreement executed with or on behalf of the Bureau for Medical
Services shall contain all necessary provisions to comply with the
provisions of Title XIX of the Social Security Act, 42 U. S. C.
§1396,
et seq., dealing with pharmacy services offered to
recipients under the medical assistance plan of West Virginia;
(B) Governments of other states and jurisdictions and their
individual departments, agencies, authorities, institutions,
programs, quasi-public corporations and political subdivisions; and
(C) Regional or multistate purchasing alliances or consortia,
formed for the purpose of pooling the combined purchasing power of
the individual members in order to increase bargaining power;
and
(4) Consider strategies by which West Virginia may manage the
increasing costs of prescription drugs and increase access to
prescription drugs for all of the state's citizens, including the
authority to:
(A) Explore the enactment of fair prescription drug pricing
policies;
(B) Explore discount prices or rebate programs for seniors and
persons without prescription drug coverage;
(C) Explore programs offered by pharmaceutical manufacturers
that provide prescription drugs for free or at reduced prices;
(D) Explore requirements and criteria, including the level of
detail, for prescription drug manufacturers to disclose to the
council expenditures for advertising, marketing and promotion,
based on aggregate national data;
(E) Explore the establishment of counter-detailing programs
aimed at educating health care practitioners authorized to
prescribe prescription drugs about the relative costs and benefits
of various prescription drugs, with an emphasis on generic
substitution for brand name drugs when available and appropriate;
prescribing older, less costly drugs instead of newer, more
expensive drugs, when appropriate; and prescribing lower dosages of
prescription drugs, when available and appropriate;
(F) Explore disease state management programs aimed at
enhancing the effectiveness of treating certain diseases identified
as prevalent among this state's population with prescription drugs;
(G) Explore prescription drug purchasing agreements with large
private sector purchasers of prescription drugs and including those
private entities in pharmacy benefit management contracts:
Provided, That no private entity may be compelled to participate in
a purchasing agreement;
(H) Explore the feasibility of using or referencing the
federal supply schedule or referencing to the price, as adjusted
for currency valuations, set by the Canada patented medicine prices
review board ("PMPRB") or any other appropriate referenced price to
establish prescription drug pricing for brand name drugs in the
state; and to review and determine the dispensing fees for pharmacies in such as established in section six of this article;
(I) Explore, if possible, joint negotiations for drug
purchasing and a shared prescription drug pricing schedule and
shared preferred drug list for use by the public employees
insurance agency, the Medicaid program, other state payors and
private insurers;
(J) Explore coordination between the medicaid program, the
Public Employees Insurance Agency and, to the extent possible,
in-state hospitals and private insurers toward the development of
a uniform preferred prescription drug list which is clinically
appropriate and which leverages retail prices;
(K) Explore policies which promote the use of generic drugs,
where appropriate;
(L) Explore a policy that precludes a drug manufacturer from
reducing the amounts of drug rebates or otherwise penalize an
insurer, health plan or other entity which pays for prescription
drugs based upon the fact that the entity uses step therapy or
other clinical programs before a drug is covered or otherwise
authorized for payment;
(M) Explore arrangements with entities in the private sector,
including self-funded benefit plans and nonprofit corporations,
toward combined purchasing of health care services, health care
management services, pharmacy benefits management services or
pharmaceutical products on the condition that no private entity be
compelled to participate in the prescription drug purchasing pool;
and
(N) Explore other strategies, as permitted under state and
federal law, aimed at managing escalating prescription drug prices
and increasing affordable access to prescription drugs for all West
Virginia citizens;
(5) Contract with appropriate legal, actuarial and other
service providers required to accomplish any function within the
powers of the council;
(6) Develop other strategies, as permitted under state and
federal law, aimed at managing escalating prescription drug prices
and increasing affordable access to prescription drugs for all West
Virginia citizens;
(7) Explore the licensing and regulation of pharmaceutical
detailers, including the requirement of continuing professional
education, the imposition of fees for licensing and continuing
education, the establishment of a special revenue account for
deposit of the fees and the imposition of penalties for
noncompliance with licensing and continuing education requirements
and rules to establish procedures to implement the provisions of
the subdivision;
(8) The council shall report
annually to the Legislature's
Joint Committee on Government and Finance on or before
the first
day of September, two thousand four, and report on or before the
thirty-first day of December, two thousand four, and annually
thereafter to the Legislature December 31 and provide
recommendations to the Legislature on needed legislative action and
other functions established by the article or requested by the Joint Committee on Government and Finance of the Legislature;
and
(9) The council shall, upon the passage of this article,
immediately commence to study the fiscal impact to this state of
the federal "Medicare Prescription Drug Improvement and
Modernization Act of 2003" and shall report to the Legislature's
joint committee on government and finance on or before the
fifteenth day of October, two thousand four, as to the findings of
the council.
(10) (9) The council shall develop an evaluation methodology
to certify and audit savings in the discount savings program by
determining the impact on growth and profit of the pharmaceutical
manufacturers to ensure that prices have not been inflated to
offset the discount card value;
(11) (10) The council shall evaluate the clearinghouse
established by this article and the discount card program
established by this article
to and report to the Joint Committee on
Government and Finance, and the Legislative Oversight Commission on
Health and Human Resources Accountability, their findings and
recommendations for further action by the Legislature;
and
(12) (11) The council shall further:
(1) (A) Review determine that the implementation of the
programs under this article will not jeopardize, reduce or penalize
the benefits of veterans or other recipients of FSS drug prices,
considering their respective copay structures, and the pricing
mechanisms of their respective programs;
(2) (B) Commence negotiations to obtain independent agreements or multistate agreements as many as ten states to use or reference
a pricing schedule as set forth in section six of this article;
and
(3) (C) and Determine the ability to establish a savings of
forty-two percent of the retail cost to be reported to the Joint
Committee on Government and Finance and the Legislative Oversight
Commission on Health and Human Resources Accountability as
established in section eight of this article.