§ 56-7-3101. Compliance
Pharmacy benefits managers shall, and contracts for pharmacy benefits management must, comply with the requirements of this part.
§ 56-7-3102. Part Definitions
As used in this part, unless the context otherwise requires: “Covered entity” means a health insurance issuer, managed health insurance issuer as defined in § 56-32-128(a), nonprofit hospital, medication service organization, insurer, health coverage plan, health maintenance organization licensed to practice pursuant to this title, a health program administered by the state or its political […]
§ 56-7-3103. Audit of Records of Pharmacist or Pharmacy
When an audit of records of a pharmacist or pharmacy is conducted by a covered entity, a pharmacy benefits manager, the state or its political subdivisions, or any other entity representing the same, it shall be conducted in the following manner: Written notice shall be given to the pharmacist or pharmacy at least two (2) […]
§ 56-7-3104. Calculation of Reimbursement of Pharmacy Benefits Manager
Reimbursement by a pharmacy benefits manager under a contract to a pharmacist or pharmacy for prescription drugs and other products and supplies that is calculated according to a formula that uses a nationally recognized reference in the pricing calculation shall use the most current nationally recognized reference price or amount in the actual or constructive […]
§ 56-7-3105. Contract Compliance
No contract entered into or amended on or after July 1, 2007, shall contain provisions in violation of this part.
§ 56-7-3106. Placement of Drug on Maximum Allowable Cost List
Before a pharmacy benefits manager or covered entity may place a drug on a maximum allowable cost list, the pharmacy benefits manager or covered entity must find that the drug is generally available for purchase by pharmacies in this state from a national or regional wholesaler. If a drug that has been placed on a […]
§ 56-7-3107. Information to Be Provided Regarding Maximum Allowable Cost Lists — Updating Maximum Allowable Cost Lists
A pharmacy benefits manager or covered entity shall make available to each pharmacy with which the pharmacy benefits manager or covered entity has a contract and to each pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, at […]
§ 56-7-3108. Appeal by Pharmacy of Cost of Particular Drug or Device on Maximum Allowable Cost List — Procedure
A pharmacy benefits manager or covered entity shall establish a clearly defined process through which a pharmacy may contest the listed maximum allowable cost for a particular drug or medical product or device. If a pharmacy chooses to contest the listed maximum allowable cost for a particular drug or medical product or device, the pharmacy […]
§ 56-7-3109. Medical Products and Devices Subject to Requirements of Part
The medical products and devices subject to the requirements of this part are limited to the medical products and devices included as a pharmacy benefit under the pharmacy benefits contract.
§ 56-7-3110. Sanctions for Violation of Part
A violation of this part may subject the pharmacy benefits manager or covered entity to any of the sanctions described in § 56-2-305.
§ 56-7-3111. Disclosure of Maximum Allowable Cost Lists and Related Information
A pharmacy shall not disclose to any third party the maximum allowable cost lists and any related information it receives from a pharmacy benefits manager or covered entity; provided, however, a pharmacy may share such lists and related information with a pharmacy services administrative organization or similar entity with which the pharmacy has a contract […]
§ 56-7-3112. Fair Disclosure of State Funded Payments for Pharmacists’ Services Act
This section shall be known and may be cited as the “Fair Disclosure of State Funded Payments for Pharmacists’ Services Act”. As used in this section: “Pharmacist” means a pharmacist as defined in § 63-10-204; “Pharmacist services” means products, goods, or services provided as a part of the practice of pharmacy as defined in § […]
§ 56-7-3113. Licensure as Pharmacy Benefits Manager
No person or entity shall administer the medication or device portion of pharmacy benefits coverage provided by a covered entity or otherwise act as a pharmacy benefits manager in this state unless the person or entity has obtained licensure through the department of commerce and insurance. To obtain licensure as a pharmacy benefits manager, the […]
§ 56-7-3114. Right to Provide Information Regarding Amount of Insured’s Cost Share of Prescription Drug
A pharmacy or pharmacist has the right to provide an insured information regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower priced drug to the […]
§ 56-7-3115. Prohibited Charges
A covered entity or pharmacy benefits manager shall not charge a pharmacist or a pharmacy a fee related to a claim unless it is apparent at the time of claim processing and is reported on the remittance advice of an adjudicated claim. This section does not prohibit a covered entity or pharmacy benefits manager from […]
§ 56-7-3116. Prohibited Terms or Conditions in Contracts
A covered entity or pharmacy benefits manager shall not include any term or condition in a contract with a pharmacy or pharmacist that requires a pharmacist to dispense a drug or other product to a patient contrary to a pharmacist’s professional judgment.
§ 56-7-3117. Disclosure of Material Changes to Contract Provisions
A covered entity or pharmacy benefits manager shall disclose to a pharmacy or pharmacist in its network, at least thirty (30) days before the date the change becomes effective, any material change to a contract provision that affects the terms of reimbursement, the process for verifying benefits and eligibility, the dispute resolution procedure, the procedure […]
§ 56-7-3118. Mutual Agreement on Terms and Conditions for Provision of Pharmacy Services — Use of Untrue, Deceptive, or Misleading Advertisement, Etc. Prohibited — Effect of Removal of Pharmacist or Pharmacy — Pattern or Practice of Reimbursing Pharmacies or Pharmacists Lesser Amount Prohibited
Each contract between a covered entity or pharmacy benefits manager and a pharmacist or pharmacy must be mutually agreed upon and must outline the terms and conditions for the provision of pharmacy services. A covered entity or pharmacy benefits manager shall not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, […]