§ 63-10-101. Short Title

This part shall be known and may be cited as the “Third-Party Prescription Program Act.”

§ 63-10-102. Part Definitions

As used in this part, “program” and “third-party prescription program” mean any system of providing for the reimbursement of pharmaceutical services under a contractual arrangement or agreement between a provider of such services and another party who is not the consumer of those services. Such programs may include, but not be limited to, employee benefit […]

§ 63-10-103. Contract Between Pharmacy and Program Administrator

Any agreement or contract entered into in this state between the program administrator of a third-party prescription program and a pharmacy shall include a statement of: The method and amount of reimbursement to the pharmacy for services rendered to persons enrolled in such program; The frequency of payment by such program administrator to the pharmacy […]

§ 63-10-104. Cancellation of Program Benefits

The administrator of a program shall notify all pharmacies enrolled in such program of any cancellation of the coverage of benefits of any group enrolled in such program at least thirty (30) days prior to the effective date of such cancellation. In those cases where the administrator of a program is not notified at least […]

§ 63-10-105. Denying or Withholding Payment

No program administrator shall deny payment for services to any pharmacy that may have resulted from the fraudulent or illegal use of an identification card by any person, unless the pharmacy has been notified that the card has been cancelled or discontinued and that the program administrator has been unsuccessful in attempting to regain possession […]

§ 63-10-106. Reimbursement Rates

No agreement between a program administrator and a pharmacy shall establish reimbursement rates or procedures that result in reimbursement rates for services rendered to persons covered by the plan that are less than the usual and customary rate charged by that vendor and paid by ordinary consumers for the same or similar services. This section […]

§ 63-10-107. Applicability

This part does not apply to any services rendered pursuant to the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1.

§ 63-10-108. Price Level Determinations

The commissioner of health, in cooperation with the board of pharmacy, shall determine the price level of prescriptions furnished under this part and those furnished otherwise. A determination shall also be made of the price level in other states having a program similar to that provided in this part and those that do not. The […]