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S1328.................................................by HEALTH AND WELFARE
PRESCRIPTION DRUGS - Adds to existing law to require a prescription drug
information card to be provided by each insurer offering disability
insurance policies or health benefit plans; to prescribe the format of the
card; to require a penalty for noncompliance; and to provide the date of
applicability.
01/24 Senate intro - 1st rdg - to printing
01/25 Rpt prt - to Health/Wel
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE SENATE
SENATE BILL NO. 1328
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO REQUIREMENTS FOR A PRESCRIPTION DRUG INFORMATION CARD; AMENDING
3 CHAPTER 21, TITLE 41, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
4 41-2147, IDAHO CODE, TO REQUIRE A PRESCRIPTION DRUG INFORMATION CARD TO BE
5 PROVIDED BY EACH INSURER OFFERING DISABILITY INSURANCE POLICIES, TO PRE-
6 SCRIBE THE FORMAT OF THE CARD, TO REQUIRE A PENALTY FOR NONCOMPLIANCE AND
7 TO PROVIDE THE DATE OF APPLICABILITY; AMENDING CHAPTER 22, TITLE 41, IDAHO
8 CODE, BY THE ADDITION OF A NEW SECTION 41-2224, IDAHO CODE, TO REQUIRE A
9 PRESCRIPTION DRUG INFORMATION CARD TO BE PROVIDED BY EACH INSURER OFFERING
10 DISABILITY INSURANCE POLICIES, TO PRESCRIBE THE FORMAT OF THE CARD, TO
11 REQUIRE A PENALTY FOR NONCOMPLIANCE AND TO PROVIDE THE DATE OF APPLICABIL-
12 ITY; AND AMENDING CHAPTER 52, TITLE 41, IDAHO CODE, BY THE ADDITION OF A
13 NEW SECTION 41-5213, IDAHO CODE, TO REQUIRE A PRESCRIPTION DRUG INFORMA-
14 TION CARD TO BE PROVIDED BY EACH INSURER OFFERING HEALTH BENEFIT PLANS, TO
15 PRESCRIBE THE FORMAT OF THE CARD, TO REQUIRE A PENALTY FOR NONCOMPLIANCE
16 AND TO PROVIDE THE DATE OF APPLICABILITY.
17 Be It Enacted by the Legislature of the State of Idaho:
18 SECTION 1. That Chapter 21, Title 41, Idaho Code, be, and the same is
19 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
20 ignated as Section 41-2147, Idaho Code, and to read as follows:
21 41-2147. PRESCRIPTION DRUG INFORMATION CARD. In order to improve care to
22 patients by minimizing confusion, eliminating unnecessary paperwork, decreas-
23 ing administrative burdens, and streamlining dispensing of prescription prod-
24 ucts paid for by third-party payors, a prescription drug information card,
25 which meets the requirements of this section, shall be provided by each
26 insurer issuing disability insurance policies for delivery in this state.
27 A prescription drug information card means any card or other technology
28 for claims processing issued to a plan enrollee and shall contain all informa-
29 tion required for proper prescription drug claims adjudication. Upon renewal
30 of a disability insurance policy, information on the prescription drug infor-
31 mation card shall be made current by the health carrier or other entity that
32 issues the card.
33 Such cards or other technology shall include all of the standard informa-
34 tion required by the plan for submission and adjudication of claims for pre-
35 scription drug or device benefits, or at a minimum contain the following
36 labeled information:
37 (1) The card issuer name or logo on the front of the card;
38 (2) The cardholder's name and identification number, which shall be dis-
39 played on the front side of the card;
40 (3) Complete information for electronic claim transactions routing
41 including:
42 (a) The international identification number labeled as RxBIN;
43 (b) The processor control number labeled as RxPCN if required for
2
1 proper routing of electronic claim transactions for prescription ben-
2 efits;
3 (c) The group number labeled as RxGrp if required for proper routing
4 of electronic claim transactions for prescription benefits;
5 (d) The name and address of the benefits administrator or other
6 entity responsible for prescription claims submission, adjudication
7 or pharmacy provider correspondence for prescription benefits claims;
8 and
9 (e) A help desk telephone number that pharmacy providers may call
10 for pharmacy benefit claims assistance.
11 Nothing in this section shall be construed to require any health carrier or
12 administrator of a disability insurance policy to issue a prescription drug
13 information card or other technology separate from another identification card
14 issued to an enrollee under the plan if the identification card contains all
15 of the information required under this section.
16 The penalty imposed for noncompliance with the provisions of this section
17 shall be not less than one thousand dollars ($1,000) per incident.
18 This section applies to disability insurance policies that are delivered,
19 issued for delivery, or renewed on or after January 1, 2003. For the purpose
20 of this section, renewal of a disability insurance policy, contract or plan
21 occurs on each anniversary of the date on which coverage was first effective
22 on the person or persons covered by the health benefit plan.
23 SECTION 2. That Chapter 22, Title 41, Idaho Code, be, and the same is
24 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
25 ignated as Section 41-2224, Idaho Code, and to read as follows:
26 41-2224. PRESCRIPTION DRUG INFORMATION CARD. In order to improve care to
27 patients by minimizing confusion, eliminating unnecessary paperwork, decreas-
28 ing administrative burdens, and streamlining dispensing of prescription prod-
29 ucts paid for by third-party payors, a prescription drug information card,
30 which meets the requirements of this section, shall be provided by each pro-
31 vider of a group or blanket disability insurance policy for delivery in this
32 state.
33 A prescription drug information card means any card or other technology
34 for claims processing issued to a plan enrollee and shall contain all informa-
35 tion required for proper prescription drug claims adjudication. Upon renewal
36 of a group or blanket disability insurance policy, information on the pre-
37 scription drug information card shall be made current by the entity that
38 issues the card.
39 Such cards or other technology shall include all of the standard informa-
40 tion required by the plan for submission and adjudication of claims for pre-
41 scription drug or device benefits, or at a minimum contain the following
42 labeled information:
43 (1) The card issuer name or logo on the front of the card;
44 (2) The cardholder's name and identification number, which shall be dis-
45 played on the front side of the card;
46 (3) Complete information for electronic claim transactions routing
47 including:
48 (a) The international identification number labeled as RxBIN;
49 (b) The processor control number labeled as RxPCN if required for
50 proper routing of electronic claim transactions for prescription ben-
51 efits;
52 (c) The group number labeled as RxGrp if required for proper routing
53 of electronic claim transactions for prescription benefits;
3
1 (d) The name and address of the benefits administrator or other
2 entity responsible for prescription claims submission, adjudication
3 or pharmacy provider correspondence for prescription benefits claims;
4 and
5 (e) A help desk telephone number that pharmacy providers may call
6 for pharmacy benefit claims assistance.
7 Nothing in this section shall be construed to require any disability insurance
8 provider or administrator of a disability insurance policy to issue a pre-
9 scription drug information card or other technology separate from another
10 identification card issued to an enrollee under the plan if the identification
11 card contains all of the information required under this section.
12 The penalty imposed for noncompliance with the provisions of this section
13 shall be not less than one thousand dollars ($1,000) per incident.
14 This section applies to disability insurance policies that are delivered,
15 issued for delivery, or renewed on or after January 1, 2003. For the purpose
16 of this section, renewal of a policy, contract, or plan occurs on each anni-
17 versary of the date on which coverage was first effective on the person or
18 persons covered by the policy.
19 SECTION 3. That Chapter 52, Title 41, Idaho Code, be, and the same is
20 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
21 ignated as Section 41-5213, Idaho Code, and to read as follows:
22 41-5213. PRESCRIPTION DRUG INFORMATION CARD. In order to improve care to
23 patients by minimizing confusion, eliminating unnecessary paperwork, decreas-
24 ing administrative burdens, and streamlining dispensing of prescription prod-
25 ucts paid for by third-party payors, a prescription drug information card,
26 which meets the requirements of this section, shall be provided by each pro-
27 vider of a health benefit plan offered in this state.
28 A prescription drug information card means any card or other technology
29 for claims processing issued to a plan enrollee and shall contain all informa-
30 tion required for proper prescription drug claims adjudication. Upon renewal
31 of a health benefit plan, information on the prescription drug information
32 card shall be made current by the health carrier or other entity that issues
33 the card.
34 Such cards or other technology shall include all of the standard informa-
35 tion required by the plan for submission and adjudication of claims for pre-
36 scription drug or device benefits, or at a minimum contain the following
37 labeled information:
38 (1) The card issuer name or logo on the front of the card;
39 (2) The cardholder's name and identification number, which shall be dis-
40 played on the front side of the card;
41 (3) Complete information for electronic claim transactions routing
42 including:
43 (a) The international identification number labeled as RxBIN;
44 (b) The processor control number labeled as RxPCN if required for
45 proper routing of electronic claim transactions for prescription ben-
46 efits;
47 (c) The group number labeled as RxGrp if required for proper routing
48 of electronic claim transactions for prescription benefits;
49 (d) The name and address of the benefits administrator or other
50 entity responsible for prescription claims submission, adjudication
51 or pharmacy provider correspondence for prescription benefits claims;
52 and
53 (e) A help desk telephone number that pharmacy providers may call
4
1 for pharmacy benefit claims assistance.
2 Nothing in this section shall be construed to require any health carrier or
3 administrator of a health benefit plan to issue a prescription drug informa-
4 tion card or other technology separate from another identification card issued
5 to an enrollee under the plan if the identification card contains all of the
6 information required under this section.
7 The penalty imposed for noncompliance with the provisions of this section
8 shall be not less than one thousand dollars ($1,000) per incident.
9 This section applies to health benefit plans that are delivered, issued
10 for delivery, or renewed on or after January 1, 2003. For the purpose of this
11 section, renewal of a health benefit policy, contract, or plan occurs on each
12 anniversary of the date on which coverage was first effective on the person or
13 persons covered by the health benefit plan.
STATEMENT OF PURPOSE
RS 11704
This legislation establishes uniform guidelines for prescription
drug card information. The information requested by this legislation
is simply the information the third party payors’ claim processor
needs to successfully process a prescription claim. The purpose of
this legislation is to improve care to patients by minimizing
confusion, eliminating unnecessary paperwork, decreasing
administrative burdens and expense, and streamlining dispensing
of prescription products paid for by third party payors.
FISCAL IMPACT
There is no fiscal impact to the general fund. Enforcement of these
sections will be by the Idaho Department of Insurance, utilizing
existing resources.
Contact: Sen. “Moon” Wheeler, 332-1409
JoAn Condie, Idaho State Pharmacy Assn., 424-1107
STATEMENT OF PURPOSE/FISCAL NOTE S 1328