§4347. Definitions As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] 1. Average wholesale price. “Average wholesale price” means the average wholesale price of a prescription drug as identified by a national drug pricing […]
§4348-A. Use of untrue, deceptive or misleading advertisement prohibited A pharmacy benefits manager or representative of a pharmacy benefits manager may not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading. [PL 2021, c. 371, §1 (NEW).] SECTION HISTORY PL 2021, c. […]
§4348. Licensure of pharmacy benefits managers Beginning January 1, 2020, a person may not act as a pharmacy benefits manager in this State without first obtaining a license from the superintendent in accordance with this section and paying the licensing fee required under section 601, subsection 28‑A. [PL 2019, c. 469, §8 (NEW); PL […]
§4349. Oversight and contracting responsibilities 1. Compliance. A carrier is responsible for monitoring all activities carried out by the carrier, or all activities carried out on behalf of the carrier by a pharmacy benefits manager if the carrier contracts with a pharmacy benefits manager, related to a carrier’s prescription drug benefits and for ensuring that […]
§4350-A. Responsibility to use compensation for benefit of covered persons 1. Compensation used to reduce point-of-sale costs, improve benefits or lower premiums. All compensation remitted by or on behalf of a pharmaceutical manufacturer, developer or labeler, directly or indirectly, to a carrier, or to a pharmacy benefits manager under contract with a carrier, related to […]
§4350-B. Prescription drug formularies; pharmacy and therapeutics committee 1. Pharmacy and therapeutics committee; use of formulary. A carrier, or a pharmacy benefits manager under contract with a carrier, shall establish a pharmacy and therapeutics committee. A carrier shall require its pharmacy and therapeutics committee or the pharmacy and therapeutics committee of the carrier’s pharmacy benefits […]
§4350-C. Access to records; audits 1. Requirements; record keeping. A carrier shall maintain and have the ability to access all data related to the administration and provision of prescription drug benefits under a health plan of a carrier, including, but not limited to: A. The names, addresses, member identification numbers, protected health information and […]
§4350-D. Treatment of pharmacy benefits manager compensation 1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. “Anticipated loss ratio” means the ratio of the present value of the future benefits payments to the present value of the future premiums of a policy form […]
§4350-E. Effective date This chapter takes effect January 1, 2020. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] SECTION HISTORY PL 2019, c. 469, §8 (NEW). PL 2019, c. 469, §9 (AFF).
§4350. Prescription drug pricing; maximum allowable cost 1. Single maximum allowable cost list. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use a single maximum allowable cost list to establish the maximum amount to be paid by a health plan to a pharmacy provider for a generic drug or a […]
