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 […]