MISSISSIPPI SUMMARY OF EXISTING LAW

New law eff. 1/1/21: (4) A PBM must: (a) Provide an appeal procedure to allow pharmacies to challenge a MAC list and reimbursements made under a MAC list for a specific drug or drugs as: (i) Not meeting the requirements of this section; or (ii) Being below the pharmacy acquisition cost. (b) The reasonable administrative appeal procedure shall include the following: (i) A dedicated telephone number, email address and website for the purpose of submitting administrative appeals; (ii) The ability to submit an administrative appeal directly to the PBM regarding the PBM plan or through a PSAO; and (iii) A period of less than 30 business days to file an administrative appeal. (c) The PBM must respond to appeal under paragraph (a) of this subsection (4) within 30 business days after receipt of the challenge. (d) If a challenge is made under paragraph (a) of this subsection (4), the PBM must within 30 business days after receipt of the challenge either: (i) If appeal upheld: (1) Make the change in the MAC list payment to at least the pharmacy acquisition cost; (2) Permit the challenging pharmacy to reverse/rebill the claim in question; (3) Provide the NDC that the increase or change is based on to the pharmacy; and (4) Make the change under item 1 of this subparagraph (i) effective for each similarly situated pharmacy as defined by the payor subject to the MAC list; or (ii) If appeal denied, provide the challenging pharmacy the NDC and the name of the national/regional pharmaceutical wholesalers operating in Mississippi that have the drug currently in stock at a price below the MAC as listed on the MAC list; or (iii) If the NDC provided by the PBM is not available below the pharmacy acquisition cost from the pharmaceutical wholesaler from whom the pharmacy purchases the majority of prescription drugs for resale, then PBM must adjust the MAC as listed on the MAC list above.

Link to Existing Law: Miss. Code Ann. § 73‐21‐156

PRACTICAL NOTE FOR EXISTING LAW

This is a new law and a very good law enacted by the Mississippi legislature.