Section 15-1633 – When Request Allowed
A pharmacy benefits manager or its agent may not request a therapeutic interchange unless: (1) the proposed therapeutic interchange is for medical reasons that benefit the beneficiary; or (2) the proposed therapeutic interchange will result in financial savings and benefits to the purchaser or the beneficiary.
Section 15-1634 – Authorization; Disclosures; Money-Saving Claims; Payment for Interchange
(a) Before making a therapeutic interchange, a pharmacy benefits manager or its agent shall obtain authorization from a prescriber or an individual authorized by the prescriber. (b) In any therapeutic interchange solicitation, the following shall be disclosed to the prescriber: (1) that a therapeutic interchange is being solicited; (2) the circumstances under which the originally prescribed drug will be […]
Section 15-1635 – Requirements When Interchange Occurs
If a therapeutic interchange occurs, the pharmacy benefits manager or its agent shall: (1) disclose to the beneficiary, orally or in writing: (i) that the pharmacy benefits manager or its agent requested a therapeutic interchange by contacting the beneficiary’s prescriber; (ii) the prescriber approved the therapeutic interchange; (iii) the names of the originally prescribed drug and the drug dispensed […]
Section 15-1636 – Cancellation and Reversal
(a) A pharmacy benefits manager or its agent shall cancel and reverse a therapeutic interchange on written or verbal instructions from a prescriber, the beneficiary, or the beneficiary’s representative. (b) If a therapeutic interchange is reversed, the pharmacy benefits manager or its agent shall: (1) obtain a prescription for and dispense the originally prescribed prescription drug; and (2) charge […]
Section 15-1637 – Maintenance of Toll-Free Telephone Number
(a) A pharmacy benefits manager shall maintain a toll–free telephone number Monday through Saturday for prescribers, pharmacies, pharmacists, and beneficiaries to request information regarding a therapeutic interchange. (b) The toll–free telephone number shall be accessible from 8 a.m. until at least 8 p.m. Eastern Standard Time.
Section 15-1638 – Privacy Standards
All disclosures made under this part shall comply with the privacy standards set forth in State and federal law.
Section 15-1639 – Policies and Procedures
A pharmacy benefits manager shall establish appropriate policies and procedures to implement the requirements of this part.