HB 943 (now Act 67) also known as the “Gag Clause Bill,” which was sponsored by Representative Valerie Gaydos (R) has been signed into law by Governor Wolf (D). HB 943 states that a pharmacy or pharmacist has the right to provide a covered individual with information concerning the cost of a prescription drug. This includes the individual’s cost-share. Additionally, under the new law a pharmacy or pharmacist may not be prohibited from or penalized by a pharmacy benefits manager for discussing the cost share information, disclosing the availability of therapeutically equivalent alternative medications, or selling to the covered individual a more affordable alternative if an affordable alternative is available. The measure applies to pharmacy benefit manager (PBM) and pharmacy services administrative organization (PSAO) contracts and is effective July 23.

Also in Pennsylvania. NACDS reminds members that pharmacies can now provide the influenza vaccine to children aged three and above according to a waiver issued by the Wolf Administration. The current statute sets the age floor at 9 years of age.

Also in Pennsylvania. The Department of Human Services (DHS) announced applicants selected through a Request for Applications (RFA) for Pennsylvania’s HealthChoices program, the Medicaid physical health managed care program. However, DHS is unable to move forward with the selections pending filed protests by three companies that were not selected. DHS may not take any further action on the procurement until the protests are resolved. The following are the managed care organizations (MCO) chosen by zone:

  • Southeast: Geisinger Health Plan, Health Partners Plans, UnitedHealthCare, UPMC for You, and Vista Health Plan (Keystone First)
  • Lehigh/Capital: Gateway Health, Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas)
  • Northeast: Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas)
  • Northwest: Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas)
  • Southwest: Gateway Health, Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas)

For more information, contact NACDS’ Jill McCormack at 717-592-8977.