§ 56-7-3301. Part Definitions
As used in this part, unless the context otherwise requires: “Health care provider” or “provider” means any person or entity performing services regulated pursuant to title 63 or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract; “Health insurance entity” has the same meaning […]
§ 56-7-3302. Clear Identification of Material Changes to Provider Manual
A health insurance entity shall provide notice to a healthcare provider of any material change made in the sole discretion of the insurance entity to the entity’s previously released provider manual or a reimbursement rule and policy at least sixty (60) days prior to the effective date of the change, and the health insurance entity […]
§ 56-7-3111. Disclosure of Maximum Allowable Cost Lists and Related Information
A pharmacy shall not disclose to any third party the maximum allowable cost lists and any related information it receives from a pharmacy benefits manager or covered entity; provided, however, a pharmacy may share such lists and related information with a pharmacy services administrative organization or similar entity with which the pharmacy has a contract […]
§ 56-7-3112. Fair Disclosure of State Funded Payments for Pharmacists’ Services Act
This section shall be known and may be cited as the “Fair Disclosure of State Funded Payments for Pharmacists’ Services Act”. As used in this section: “Pharmacist” means a pharmacist as defined in § 63-10-204; “Pharmacist services” means products, goods, or services provided as a part of the practice of pharmacy as defined in § […]
§ 56-7-3113. Licensure as Pharmacy Benefits Manager
No person or entity shall administer the medication or device portion of pharmacy benefits coverage provided by a covered entity or otherwise act as a pharmacy benefits manager in this state unless the person or entity has obtained licensure through the department of commerce and insurance. To obtain licensure as a pharmacy benefits manager, the […]
§ 56-7-3114. Right to Provide Information Regarding Amount of Insured’s Cost Share of Prescription Drug
A pharmacy or pharmacist has the right to provide an insured information regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower priced drug to the […]
§ 56-7-3115. Prohibited Charges
A covered entity or pharmacy benefits manager shall not charge a pharmacist or a pharmacy a fee related to a claim unless it is apparent at the time of claim processing and is reported on the remittance advice of an adjudicated claim. This section does not prohibit a covered entity or pharmacy benefits manager from […]
§ 56-7-3116. Prohibited Terms or Conditions in Contracts
A covered entity or pharmacy benefits manager shall not include any term or condition in a contract with a pharmacy or pharmacist that requires a pharmacist to dispense a drug or other product to a patient contrary to a pharmacist’s professional judgment.
§ 56-7-3117. Disclosure of Material Changes to Contract Provisions
A covered entity or pharmacy benefits manager shall disclose to a pharmacy or pharmacist in its network, at least thirty (30) days before the date the change becomes effective, any material change to a contract provision that affects the terms of reimbursement, the process for verifying benefits and eligibility, the dispute resolution procedure, the procedure […]
§ 56-7-3118. Mutual Agreement on Terms and Conditions for Provision of Pharmacy Services — Use of Untrue, Deceptive, or Misleading Advertisement, Etc. Prohibited — Effect of Removal of Pharmacist or Pharmacy — Pattern or Practice of Reimbursing Pharmacies or Pharmacists Lesser Amount Prohibited
Each contract between a covered entity or pharmacy benefits manager and a pharmacist or pharmacy must be mutually agreed upon and must outline the terms and conditions for the provision of pharmacy services. A covered entity or pharmacy benefits manager shall not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, […]