Sec. 21.27.940. Pharmacy audits; restrictions.
The requirements of AS 21.27.901 – 21.27.955 do not apply to an audit (1) in which suspected fraudulent activity or other intentional or wilful misrepresentation is evidenced by a physical review, a review of claims data, a statement, or another investigative method; or (2) of claims paid for under the medical assistance program under AS […]
Sec. 21.27.945. Drug pricing list; procedural requirements.
(a) A pharmacy benefits manager shall (1) make available to each network pharmacy at the beginning of the term of the network pharmacy’s contract, and upon renewal of the contract, the methodology and sources used to determine the drug pricing list; (2) provide a telephone number at which a network pharmacy may contact an employee […]
Sec. 21.27.950. Multi-source generic drug appeal.
(a) A pharmacy benefits manager shall establish a process by which a network pharmacy, or a network pharmacy’s contracting agent, may appeal the reimbursement for a multi-source generic drug. A pharmacy benefits manager shall resolve an appeal from a network pharmacy within 10 calendar days after the network pharmacy or the contracting agent submits the […]
Sec. 21.27.955. Definitions.
In AS 21.27.901 – 21.27.955, (1) “audit” means an official examination and verification of accounts and records; (2) “claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device; (3) “extrapolation” means the practice […]
Sec. 21.27.990. Definitions.
In this chapter, (1) “accredited state” means a state in which the insurance department or regulatory agency of that state has qualified as meeting the minimum financial regulatory standards adopted and established by the National Association of Insurance Commissioners; (2) “affiliate” or “affiliated” has the meaning given in AS 21.22.200; (3) “appointment” means an act […]
Sec. 21.27.901. Registration of pharmacy benefits managers; scope of business practice.
(a) A person may not conduct business in the state as a pharmacy benefits manager unless the person is registered with the director as a third-party administrator under AS 21.27.630. (b) A pharmacy benefits manager registered under AS 21.27.630 may (1) contract with an insurer to administer or manage pharmacy benefits provided by an insurer […]
Sec. 21.27.905. Renewal of registration.
(a) A pharmacy benefits manager shall biennially renew a registration with the director. (b) To renew a registration under this section, a pharmacy benefits manager shall pay a renewal fee established by the director. The director shall set the amount of the renewal fee to allow the renewal and oversight activities of the division to […]
Sec. 21.27.910. Pharmacy audit procedural requirements.
(a) When a pharmacy benefits manager conducts an audit of the records of a pharmacy, the period covered by the audit of a claim may not exceed two years from the date that the claim was submitted to or adjudicated by the pharmacy benefits manager, whichever is earlier. Except as required under AS 21.36.495, a […]
Sec. 21.27.915. Overpayment or underpayment.
(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base a finding of overpayment or underpayment by the pharmacy on the actual overpayment or underpayment and not on a projection based on the number of patients served having a similar diagnosis or on the number of similar […]
Sec. 21.27.730. Reinsurance intermediary manager qualifications.
In addition to the general qualifications under AS 21.27.020, the director may require that a reinsurance intermediary manager maintain (1) a bond in an amount acceptable to the director that requires the reinsurance intermediary manager to conduct business under this title; and (2) an errors and omissions insurance policy acceptable to the director.