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.
Sec. 21.27.920. Recoupment.
(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base the recoupment of overpayments on the actual overpayment of the claim, except as provided in AS 21.27.915(b). (b) A pharmacy benefits manager conducting an audit of a pharmacy may not (1) use extrapolation in calculating recoupments or […]
Sec. 21.27.750. Authority of reinsurance intermediary managers.
A reinsurance intermediary manager has only the authority that is consistent with this title and that is conferred by the reinsurer. A reinsurance intermediary manager, resident or nonresident, qualified and licensed under this chapter, may exercise the powers conferred by this title upon insurance producers and independent adjusters only for the kinds or classes of […]
Sec. 21.27.925. Pharmacy audit reports.
(a) A pharmacy benefits manager shall deliver a preliminary audit report to the pharmacy audited within 60 days after the conclusion of the audit. (b) A pharmacy benefits manager shall allow the pharmacy at least 30 days following receipt of the preliminary audit report to provide documentation to the pharmacy benefits manager to address a […]
Sec. 21.27.760. Operating requirements for reinsurance intermediary managers; actions for loss.
(a) A reinsurer may not transact business with a reinsurance intermediary manager unless there is in effect a written contract approved by the reinsurer’s board of directors between the parties that establishes the responsibilities of each party, indicates each party’s share of responsibility for each particular function, and specifies the division of responsibilities. (b) The […]
Sec. 21.27.930. Pharmacy audit appeal; future repayment.
(a) A pharmacy benefits manager conducting an audit shall establish a written appeals process. (b) Recoupment of disputed funds or repayment of funds to the pharmacy benefits manager by the pharmacy, if permitted by contract, shall occur, to the extent demonstrated or documented in the pharmacy audit findings, after final internal disposition of the audit, […]