TACT Act of 2023

This bill amends the Public Health Service Act to improve patient access to oral medications by setting new requirements for group health plans, health insurance issuers, and their contracted pharmacies. It establishes timelines for pharmacies to confirm and dispense prescriptions, provides patient options if a pharmacy cannot fill a prescription within 72 hours, and mandates coverage and payment rules for alternate pharmacies.

Sec. 2, Patient access to oral medications: This section adds a new subsection (f) to section 2719A of the Public Health Service Act. It requires that if a group health plan or health insurance issuer covers oral medications and contracts with a pharmacy, the contract must require the pharmacy to: confirm receipt of a prescription within 24 hours, inform the prescriber and plan within 24 hours whether it will dispense by 72 hours, dispense by 72 hours if able, or if unable, immediately provide written notice to the prescriber, plan, and patient explaining the inability and the option to use an alternate pharmacy. If the pharmacy fails to communicate or dispense, it is deemed unable to fill. The plan or issuer must then authorize the patient to select any licensed pharmacy within a reasonable distance or able to deliver within 48 hours, and must cover the medication and pay the alternate pharmacy without prior authorization, with cost-sharing no greater than for in-network pharmacies, and counting toward in-network deductibles and out-of-pocket maximums. Prior authorization decisions must be made within 72 hours; if not, the patient may use an alternate pharmacy. Quality measures in incentive payment systems must be relevant to pharmacy performance. 'Oral medication' is defined as a drug or biological taken by mouth, dispensed as an outpatient, for a medically accepted indication. A conforming amendment clarifies that the new subsection is separate from existing provisions. The Comptroller General must report within two years on the effects of this subsection on timely patient access, including time comparisons, health outcomes, costs, and fraud risk assessments. The amendments apply to plan years starting on or after January 1, 2024.