§ 127673.05
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/ca/health-and-safety-code/127673-05A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)For purposes of this section, “pharmacy benefits manager” or “PBM” means an entity that is required to be licensed pursuant to Section 1385.008.
(b)Notwithstanding any other state law, for the purpose of providing information for inclusion in the system, PBMs shall provide to the department data regarding drug pricing, the fees paid for pharmacy benefit management services, payments or rebates to or from pharmacy benefits managers regarding drugs or services, and other information as needed to provide transparency on pricing and payments related to prescription drugs. This may include all of the following:
(1)Drug codes, names, therapeutic category, and manufacturer.
(2)Wholesale acquisition costs.
(3)Average wholesale prices.
(4)National average drug acquisition cost.
(5)Fees paid to pharmacy benefit managers by manufacturers, health care service plans, health insurers, employers, and pharmacies.
(6)Prescription counts.
(7)Member counts.
(8)Payment amounts collected and paid by pharmacy benefit managers.
(9)Discounts and rebate amounts collected and paid by pharmacy benefit managers.
(10)Information grouped by National Drug Code and Generic Product Identifier.
(11)Information grouped by pharmacies owned by, or under common control of, the pharmacy benefit manager and pharmacies not owned by, or under common control of, the pharmacy benefit manager.
(12)Information grouped by business relationship, including by exclusive relationships under a contract, agreement, or other arrangement between a pharmacy benefit manager and a pharmaceutical manufacturer to exclusively dispense or provide a drug to a health care service plan’s or health insurer’s employees, enrollees, or insureds.
(13)Information needed to calculate any of the following:
(A)The number of participants or beneficiaries who filled a prescription.
(B)Total out-of-pocket spending by participants or beneficiaries.
(C)Total net price by drug.
(D)Payer total net spending by drug.
(E)Payer average net spending per 30-day and 90-day supply.
(F)Percentage of prescriptions dispensed by pharmacies owned by, or under common control of, the pharmacy benefit manager.
(G)Comparisons of the amounts charged to patients and payers by pharmacies owned by, or under common control of, the pharmacy benefit manager, with the amounts charged by pharmacies not owned by, or under common control of, the pharmacy benefit manager.
(H)Average sales price of drugs dispensed at pharmacies owned by, or under common control of, the pharmacy benefit manager.
(I)Average wholesale acquisition cost of drugs dispensed at pharmacies owned by, or under common control of, the pharmacy benefit manager.
(J)Average drug acquisition cost per dosage unit of drugs dispensed at pharmacies owned by, or under common control of, the pharmacy benefit manager.
(K)Average drug acquisition cost per 30-day and 90-day supply.
(c)The department shall promulgate regulations for the purpose of carrying out this section, including regulations relating to the content, file formats, frequency, and timelines for data submission by pharmacy benefit managers. In the development of regulations, the department may consider national or regional standards and standards from other databases.
(d)Until January 1, 2028, any necessary rules and regulations for the purpose of implementing this section may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The adoption of emergency regulations pursuant to this section shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare.
(e)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, including subdivisions
(e)and
(h)of Section 11346.1 of the Government Code, an emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the office pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code within two years of the initial adoption of the emergency regulation.
(f)In its initial implementation of this section, the department shall seek historical data for three years before the effective date of the regulations described in subdivision (d).
(g)The provisions of this section are severable. If any provision of this section or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.