2018 -- S 2532

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LC004815

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

RELATING TO INSURANCE -- PRESCRIPTION DRUG BENEFITS--PRESCRIPTION

DRUG MARKETING

     Introduced By: Senators Miller, Goldin, Calkin, Satchell, and Raptakis

     Date Introduced: March 01, 2018

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-20.8 of the General Laws entitled "Prescription Drug Benefits"

is hereby amended by adding thereto the following section:

     27-20.8-3. Fair marketing of prescription drugs.

     (a) Legislative purpose. Health insurance premiums are increasing in large part due to

prescription drug expenses. Drug manufacturers employ direct-to-consumer marketing schemes,

including coupons, discount cards, and similar offers, to disguise the true costs of high priced

drugs. Controlling the application of these marketing programs, especially when lower cost

alternatives are available, will help eliminate an expense that drives up the cost of health care for

Rhode Islanders. These marketing schemes are prohibited for Medicare, Medicaid, and other

federally-funded programs because they increase the costs to those programs. Similar protections

should be provided for those paying the premiums for commercial coverage. Furthermore, where

the drug makers are willing to offer these ''discounts" to patients with insurance, they should

provide similar assistance to help those patients without coverage. This section addresses those

cost issues.

     (b) A person who manufactures a prescription drug who offers or makes available to an

insured in this state any discount, repayment, product voucher, or similar mechanism that

provides a reduction in an individual's out-of-pocket expenses associated with their health

insurance, shall permit such mechanism to be used by a person without health insurance coverage

for that prescription drug.

     (c) A person who manufactures a prescription drug who offers or makes available to an

insured in this state any discount, repayment, product voucher, or similar mechanism, shall

publish on the discount card, coupon, voucher, or similar material, and on any accompanying

advertisement and website, in an easily readable font and understandable format, a message that a

generic alternative has been approved by the United States Food and Drug Administration (FDA),

that the generic may be available at a lower price, and instructions for the dispensing pharmacist

to inform the person obtaining the prescription about any generic alternative.

     (1) For the purpose of this section, a '"genetic alternative" means a drug designated to be

therapeutically equivalent as indicated by the FDA's '"Approved Drug Products with Therapeutic

Equivalence Evaluations." Subsection (c) of this section shall not apply to a branded prescription

drug until the time that the first drug designated in the FDA's "Approved Drug Products with

Therapeutic Equivalence Evaluations" as therapeutically equivalent to that branded prescription

drug has been nationally available, or, the active ingredients of the drug are contained in products

regulated by the FDA, are available without prescription at a lower cost, and are not otherwise

contraindicated for treatment of the condition for which the prescription drug is approved.

     (d) A health plan shall be permitted to adopt a variable copayment and/or out-of-pocket

maximum calculation process. Notwithstanding any state law to the contrary, and to the extent

permissible by federal law, a health plan may:

     (1) Adopt a cost sharing method that provides for an adjustment to the cost sharing to

reflect the full value of a discount, repayment, product voucher or similar mechanism; and/or

     (2) Adopt a method to calculate the out-of-pocket maximum that only accumulates

toward the maximum those payments made by the insured and not those made by a drug

manufacturer via such mechanisms.

     (e) This section does not prohibit or in any way restrict an entity, including an entity that

manufactures prescription drugs or a patient assistance program that is solely funded by one or

more manufacturers, from offering a pharmaceutical product free of any cost, if the product is

free of cost to both the patient and the patient's health insurance carrier.

     (f) This section does not prohibit or in any way restrict a discount, repayment, product

voucher, or other reduction in an individual's out-of-pocket expenses that is not associated with

the individuals health insurance and the individual's health insurance is not paying any portion of

the cost of the prescription drug.

     SECTION 2. This act shall take effect on January 1, 2019.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- PRESCRIPTION DRUG BENEFITS--PRESCRIPTION

DRUG MARKETING

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     This act would regulate the marketing of prescription drug manufacturers using direct-to-

consumer marketing schemes including coupons, discount cards and similar offers to disguise the

true costs of high priced drugs as opposed to lower cost alternatives and making these discounts

available to individuals without health insurance.

     This act would take effect on January 1, 2019.

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