Section 318:66 – Applicability.
318:66 Applicability. – This subdivision shall not apply to any audit, review, or investigation that is based on suspected or alleged fraud, willful misrepresentation, or abuse. Nothing in this subdivision shall apply to claims that were paid for in part or in whole by Medicare or Medicaid program funds. Source. 2013, 159:1, eff. Jan. […]
Section 318:67 – Definitions.
318:67 Definitions. – In this subdivision: I. " Department " means the insurance department. II. " Manufacturer " means any entity which is engaged in the production, preparation, propagation, compounding, conversion, or processing of prescription drugs, whether directly or indirectly by extraction from substances of natural origin, independently by means of chemical synthesis, or […]
Section 318:68 – Notice Required.
318:68 Notice Required. – I. A prescription drug manufacturer shall notify the department in writing if it is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D program. The manufacturer shall provide the written notice within 3 […]
Section 318:60 – Limited Immunity.
318:60 Limited Immunity. – I. Accepting or dispensing of a prescription drug manufactured by the prescription drug manufacturer that is donated by any entity pursuant to this subdivision shall not subject a prescription drug manufacturer to criminal or civil liability for injury, death, or loss to person or property for failure to transfer or […]
Section 318:61 – Definition.
318:61 Definition. – In this subdivision, " responsible party " means the entity responsible for payment of claims for health care services other than the individual to whom the health care services were rendered or that individual’s guardian or legal representative. Source. 2013, 159:1, eff. Jan. 1, 2014.
Section 318:62 – Pharmacy Rights During Audit.
318:62 Pharmacy Rights During Audit. – Notwithstanding any other provision of law, whenever a managed care company, insurance company, third-party payer, or any entity that represents a responsible party conducts an audit of the records of a pharmacy, the pharmacy has a right to all of the following: I. To have at least 7 […]
Section 318:63 – Mandatory Appeals Process.
318:63 Mandatory Appeals Process. – I. Each entity that conducts an audit of a pharmacy shall establish an appeals process under which a pharmacy may appeal within 30 days after the report an unfavorable audit report to the entity. II. If, following the appeal, the entity finds that an unfavorable audit report or any […]
Section 318:64 – Pharmacy Audit Recoupments.
318:64 Pharmacy Audit Recoupments. – I. Recoupments of any disputed funds shall occur only after final internal disposition of an audit, including the appeals process, unless fraud or misrepresentation is reasonably suspected or the discrepant amount exceeds $10,000. II. Recoupment on an audit shall be refunded to the responsible party as contractually agreed upon […]
Section 318:65 – Audit Information and Reports.
318:65 Audit Information and Reports. – An audit report shall be delivered to the pharmacy within 75 days, unless otherwise agreed to, after the conclusion of the audit. A pharmacy shall be allowed at least 30 days, unless otherwise agreed to, following receipt of the audit report to appeal any discrepancy found in the […]
Section 318:52-c – Sale of Hypodermic Syringes and Needles.
318:52-c Sale of Hypodermic Syringes and Needles. – I. No person shall sell, furnish, or give to any person, under 18 years of age, an instrument commonly known as a hypodermic syringe, hypodermic needle, or any instrument adapted for the administration of drugs by injection without the written or oral prescription of a licensed […]