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 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 […]
Section 307 – Pharmacy benefit manager reporting.
Effective 5/12/2020 31A-46-307. Pharmacy benefit manager reporting. (1) A pharmacy benefit manager may not enter into or renew a contract with an insurer on or after January 1, 2021, to administer or manage rebate contracting or rebate administration unless the pharmacy benefit manager agrees to regularly report to the insurer information regarding pharmaceutical manufacturer rebates […]
Section 308 – Out-of-state mail service pharmacies — Drugs not readily available in all pharmacies.
Effective 5/12/2020 31A-46-308. Out-of-state mail service pharmacies — Drugs not readily available in all pharmacies. (1) As used in this section, “out-of-state mail service pharmacy” means the same as that term is defined in Section 58-17b-102. (2) Except as provided in Subsection (3), a third party payor of pharmaceutical services within the state, or its […]
Section 309 – Reimbursement — Prohibitions.
Effective 5/12/2020 31A-46-309. Reimbursement — Prohibitions. (1) This section applies to a contract entered into or renewed on or after January 1, 2021, between a pharmacy benefit manager and a pharmacy. (2) A pharmacy benefit manager may not vary the amount it reimburses a pharmacy for a drug on the basis of whether: (a) the […]
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 […]