Section 310 – Prohibited actions with respect to a federally qualified health center.
Effective 5/5/2021 31A-46-310. Prohibited actions with respect to a federally qualified health center. (1) As used in this section, “federally qualified health center”: (a) means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and (b) includes the pharmacy or pharmacies that are operated by or contract with a federally qualified health […]
Section 401 – Penalties.
Effective 7/1/2019 31A-46-401. Penalties. A person that violates a provision of this chapter is subject to the penalties described in Section 31A-2-308. Enacted by Chapter 241, 2019 General Session
Section 402 – Severability.
Effective 7/1/2019 31A-46-402. Severability. If any provision of this chapter or the application of any provision of this chapter is found invalid, the remainder of this chapter shall be given effect without the invalid provision or application. Enacted by Chapter 241, 2019 General Session
Section 103 – Manufacturer reports — Insurer report — Publication by department.
Effective 5/4/2022 31A-48-103. Manufacturer reports — Insurer report — Publication by department. (1) (a) A manufacturer of a drug shall, beginning January 1, 2022, report to the department the information described in Subsection (1)(b) no more than 30 days after the day on which an increase to the wholesale acquisition cost of the drug results […]
Section 202 – Application for licensure.
Effective 7/1/2019 31A-46-202. Application for licensure. (1) To obtain or renew a license as a pharmacy benefit manager, a person shall: (a) submit an application to the commissioner on forms and in a manner established by the commissioner by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and (b) pay […]
Section 302 – Direct or indirect remuneration by pharmacy benefit managers — Disclosure of customer costs — Limit on customer payment for prescription drugs.
Effective 5/12/2020 31A-46-302. Direct or indirect remuneration by pharmacy benefit managers — Disclosure of customer costs — Limit on customer payment for prescription drugs. (1) If a pharmacy service entity engages in direct or indirect remuneration with a pharmacy, the pharmacy service entity shall make a reimbursement report available to the pharmacy upon the pharmacy’s […]
Section 303 – Insurer and pharmacy benefit management services — Registration — Maximum allowable cost — Audit restrictions.
Effective 5/12/2020 31A-46-303. Insurer and pharmacy benefit management services — Registration — Maximum allowable cost — Audit restrictions. (1) An insurer and an insurer’s pharmacy benefit manager is subject to the pharmacy audit provisions of Section 58-17b-622. (2) A pharmacy benefit manager shall not use maximum allowable cost as a basis for reimbursement to a […]
Section 304 – Claims practices.
Effective 5/12/2020 31A-46-304. Claims practices. (1) A pharmacy benefit manager shall permit a pharmacy to collect the amount of a customer’s cost share from any source. (2) A pharmacy benefit manager may not deny or reduce a reimbursement to a pharmacy or a pharmacist after the adjudication of the claim, unless: (a) the pharmacy or […]
Section 305 – Pharmacy reimbursement.
Effective 5/12/2020 31A-46-305. Pharmacy reimbursement. A pharmacy benefit manager shall reimburse a network pharmacy, in the aggregate, in an amount no less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benefit manager in the same network, in the aggregate, for providing the same or equivalent pharmacy service. Enacted by […]
Section 306 – Mailing or delivering prescription drugs.
Effective 5/12/2020 31A-46-306. Mailing or delivering prescription drugs. A pharmacy benefit manager or an insurer may not, directly or indirectly: (1) prohibit an in-network retail pharmacy from: (a) mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network retail pharmacy; (b) charging a shipping or handling fee to an […]