33-2-2405. Marketing and advertising
33-2-2405. Marketing and advertising. (1) A pharmacy benefit manager may not cause or knowingly permit the use of an advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading. (2) The commissioner may not review or approve a pharmacy benefit manager’s marketing or advertising documents prior to use by the pharmacy benefit manager. (3) The […]
33-2-2406. Pharmacy benefit manager transparency to carriers and plan sponsors
33-2-2406. Pharmacy benefit manager transparency to carriers and plan sponsors. (1) Beginning in the second quarter after the effective date of a contract between a pharmacy benefit manager and a health carrier, plan sponsor, or workers’ compensation insurance carrier, the pharmacy benefit manager shall disclose, within 45 days of a request of the health carrier, plan […]
33-2-2407. Transparency report to the commissioner
33-2-2407. Transparency report to the commissioner. (1) By July 1 each year for the immediately preceding calendar year, each pharmacy benefit manager doing business in this state shall report to the commissioner on a form prescribed by the commissioner the following information regarding prescription drug benefits provided to enrollees of each health carrier and plan sponsor […]
33-2-2408. Pharmacy benefit manager appeals report
33-2-2408. Pharmacy benefit manager appeals report. (1) Pharmacy benefit managers shall track, monitor, and report to the commissioner each quarter the following aggregated information related to appeals filed pursuant to 33-22-173: (a) the number of appeals filed by pharmacies; (b) whether the appeals were denied or upheld by the pharmacy benefit manager and, if denied, the reasons for […]
33-2-2409. Network adequacy
33-2-2409. Network adequacy. (1) A pharmacy benefit manager shall provide an adequate and accessible pharmacy network for the provision of prescription drugs to ensure reasonable proximity of pharmacies to the businesses or personal residences of enrollees and injured workers. (2) In determining whether a pharmacy benefit manager has complied with the requirements of this section, consideration must […]
33-2-2410. Federal 340B drug pricing program
33-2-2410. Federal 340B drug pricing program. A pharmacy benefit manager or health carrier may not: (1) prohibit a federally certified health entity or a pharmacy under contract with an entity to provide pharmacy services from participating in the pharmacy benefit manager’s or health carrier’s provider network; (2) reimburse a federally certified health entity or a pharmacy under contract […]
33-2-2411. Enforcement — penalties
33-2-2411. Enforcement — penalties. (1) The commissioner shall enforce the provisions of this part, 33-22-170 through 33-22-177, and 33-22-180 and may examine the affairs of a pharmacy benefit manager to determine compliance with the provisions. (2) Any examination under this section must follow the examination procedures and requirements applicable to insurers under Title 33, chapter 1, part […]
33-2-2412. Rulemaking
33-2-2412. Rulemaking. The commissioner may adopt rules as necessary to implement the provisions of this part. History: En. Sec. 12, Ch. 501, L. 2021.
33-2-2303. Disclosures by air ambulance service
33-2-2303. Disclosures by air ambulance service. An out-of-network nonhospital-controlled air ambulance service must disclose by July 1 of each year any relationships or financial arrangements with health care providers, insurers, or health plans. This includes but is not limited to employment arrangements, ownership interests, first call agreements, and board memberships. This information must be filed with […]
33-2-2304. Independent dispute resolution
33-2-2304. Independent dispute resolution. (1) If an insurer or health plan and air ambulance service enter into dispute resolution, the procedure in 33-2-2305 is to be used to determine the fair market price of the services that are the subject of the claim. (2) Payment of the fair market price calculated pursuant to 33-2-2305 constitutes payment in […]