,i #aaith ,,congress #b;d ,session ,h4 ,r4 #ajedi ,,in ,,the ,,house ,,of ,,representatives ,september #bd1 #bjbf,mr4 ,dunn of ,florida 7for himself and ,mr4 ,wilson of ,south ,carolina7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xxvii of the ,public ,health ,service ,act to prohibit certain group health plans and health insurance issuers from limiting choice in specialty pharmacies4 #a4 ,short title ,this ,act may be cited as the ,patients ,choice in ,specialty ,pharmacy ,act4 #b4 ,prohibiting certain group health plans and health insurance issuers from limiting choice in specialty pharmacies 7a7 ,in general ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is amended by adding at the end the following new section3 #bgcj4 ,prohibition on limiting specialty pharmacy choice 7a7 ,prohibition on steering to affiliated specialty pharmacies ,a group health plan 7other than a self-insured group health plan7 or a health insurance issuer offering group or individual health insurance coverage may not require1 steer1 or induce an enrollee in the plan or coverage to obtain a prescription drug for which benefits are available under the plan or coverage from an affiliated specialty pharmacy1 including by-- 7#a7 imposing higher cost sharing1 including copayments1 coinsurance1 or deductibles1 when such drug is dispensed by a specialty pharmacy that is not an affiliated specialty pharmacy2 7#b7 offering a discount1 rebate1 or other financial incentive that is conditioned on the enrollee obtaining such drug from an affiliated specialty pharmacy2 or 7#c7 imposing a penalty1 delay1 or other administrative burden on an enrollee 7or the health care provider prescribing such drug to such enrollee7 who obtains 7or directs such enrollee to obtain7 such drug from a specialty pharmacy that is not an affiliated specialty pharmacy4 7b7 ,limitation on excluding qualified specialty pharmacies from network 7#a7 ,in general ,subject to paragraph 7#b71 a group health plan 7other than a self-insured group health plan7 or a health insurance issuer offering group or individual health insurance coverage may not refuse to contract with1 or otherwise exclude from the network of the plan or coverage1 any specialty pharmacy that-- 7,a7 is licensed and in good standing under the laws of the ,state in which it dispenses the drug2 7,b7 agrees to meet all terms and conditions of network participation that are uniformly applied to all specialty pharmacies in the network of the plan or coverage1 which may include1 at the option of the plan or issuer1 a requirement that the specialty pharmacy maintain accreditation from a nationally recognized accrediting organization2 and 7,c7 is willing to accept the same reimbursement rates as other specialty pharmacies in the network of the plan or coverage4 7#b7 ,exclusion allowed for good cause ,the requirement under paragraph 7#a7 shall not apply with respect to a group health plan 7other than a self-insured group health plan7 or a health insurance issuer offering group or individual health insurance coverage and a specialty pharmacy in the case that-- 7,a7 such specialty pharmacy-- 7i7 has been convicted under ,federal or ,state law of an offense related to fraud or abuse2 or 7ii7 has been subjected to disciplinary action by a ,state board of pharmacy in connection with activities related to fraud or abuse2 7,b7 such specialty pharmacy has been excluded or suspended from participation in the ,medicare program under title ,,xviii of the ,social ,security ,act1 or a ,state health care program 7as defined in section #aabh7;h7 of such ,act72 or 7,c7 the plan or issuer demonstrates to the ,state board of pharmacy or other competent regulatory authority that contracting with such specialty pharmacy poses an imminent risk of patient harm4 7c7 ,definitions ,in this section3 7#a7 ,affiliated specialty pharmacy ,the term affiliated specialty pharmacy means1 with respect to a group health plan 7other than a self-insured group health plan7 or a health insurance issuer offering group or individual health insurance coverage1 a specialty pharmacy-- 7,a7 with respect to which such plan or issuer 7or an entity providing pharmacy benefit management services on behalf of such plan or issuer7 is a person with an ownership or control interest 7as defined in section #aabd7;a77#c7 of the ,social ,security ,act72 or 7,b7 with respect to which such plan or issuer 7or an entity providing pharmacy benefit management services on behalf of such plan or issuer7 otherwise exercises 7directly or indirectly7 operational1 financial1 or managerial control4 7#b7 ,nationally recognized accrediting organization ,the term nationally recognized accrediting organization means-- 7,a7 the ,joint ,commission on ,health ,care ,organizations2 7,b7 the ,utilization ,review ,accreditation ,commission2 or 7,c7 the ,accreditation ,commission for ,health ,care4 7#c7 ,specialty pharmacy ,the term specialty pharmacy means a pharmacy that-- 7,a7 is licensed and in good standing under the laws of the ,state in which it dispenses drugs2 7,b7 dispenses drugs that-- 7i7 require handling1 storage1 administration1 or monitoring exceeding that customarily required for most retail prescription drugs2 or 7ii7 are used in the treatment of complex1 expensive1 or rare health conditions2 and 7,c7 has the capability1 consistent with applicable ,state law1 to provide clinical and patient support services appropriate to the dispensing of drugs described in subparagraph 7,b71 which may include patient education1 adherence support1 care coordination with the prescribing provider1 and monitoring for adverse events4 4 7b7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjbi4