Chief Sponsor: Evan J. Vickers

House Sponsor: Steve Eliason


8     General Description:
9          This bill amends provisions relating to pharmacies that are operated by or contract with
10     a federally qualified health center.
11     Highlighted Provisions:
12          This bill:
13          ▸     defines terms; and
14          ▸     prohibits certain actions by a pharmacy benefit manager or third party with respect
15     to a federally qualified health center that participates in the 340B discount drug
16     program.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     ENACTS:
23          31A-46-310, Utah Code Annotated 1953

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 31A-46-310 is enacted to read:
27          31A-46-310. Prohibited actions with respect to a federally qualified health center.

28          (1) As used in this section, "federally qualified health center":
29          (a) means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and
30          (b) includes the pharmacy or pharmacies that are operated by or contract with a
31     federally qualified health center described in Subsection (1)(a) to dispense drugs purchased
32     through the federally qualified health center.
33          (2) This section applies to a contract entered into or renewed on or after January 1,
34     2022, between an insurer and a pharmacy described in Subsection (1)(b).
35          (3) An insurer may not vary the amount that the insurer reimburses to a federally
36     qualified health center for a drug on the basis of whether:
37          (a) the drug is a 340B drug; or
38          (b) the pharmacy is a 340B entity.
39          (4) Subsection (3) does not apply to a drug reimbursed, directly or indirectly, by the
40     Medicaid program.
41          (5) An insurer or an insurer's pharmacy service entity may not:
42          (a) on the basis that a federally qualified health center participates, directly or through a
43     contractual arrangement, in the 340B drug discount program:
44          (i) assess a fee, charge-back, or other adjustment on a federally qualified health center;
45          (ii) restrict access to the insurer's pharmacy network;
46          (iii) require the federally qualified health center to enter into a contract with a specific
47     pharmacy to participate in the insurer's pharmacy network;
48          (iv) create a restriction or an additional charge on a patient who chooses to receive
49     drugs from a federally qualified health center; or
50          (v) create any additional requirements or restrictions on the federally qualified health
51     center; or
52          (b) require a claim for a drug to include a modifier to indicate that the drug is a 340B
53     drug unless the claim is for payment, directly or indirectly, by the Medicaid program.