Section 27-45A-1 – Short Title.
Section 27-45A-1 Short title. This chapter shall be known as and may be cited as the Alabama Pharmacy Benefits Manager Licensure and Regulation Act. (Act 2019-457, §1.)
Section 27-45A-10 – Pharmacy Benefits Managers – Prohibited Activities Related to Pharmacies or Pharmacists.
Section 27-45A-10 Pharmacy benefits managers – Prohibited activities related to pharmacies or pharmacists. A pharmacy benefits manager may not do any of the following: (1) Reimburse an in-network pharmacy or pharmacist in the state an amount less than the amount that the pharmacy benefits manager reimburses a similarly situated PBM affiliate for providing the same […]
Section 27-45A-11 – Pharmacy Benefits Managers – Material Misrepresentations.
Section 27-45A-11 Pharmacy benefits managers – Material misrepresentations. A pharmacy benefits manager may not knowingly make a material misrepresentation to a covered individual, pharmacist, or pharmacy. (Act 2021-341, §2.)
Section 27-45A-12 – Use of Pharmacy Benefits of a Covered Individual.
Section 27-45A-12 Use of pharmacy benefits of a covered individual. A pharmacist or pharmacy that participates in a health benefit plan’s pharmacy network shall process a prescription drug using the pharmacy benefits of the covered individual if failure to do so will result in a higher out-of-pocket cost to the covered individual. (Act 2021-341, §2.)
Section 27-45A-2 – Legislative Intent.
Section 27-45A-2 Legislative intent. (a) This chapter establishes the standards and criteria for the regulation and licensure of pharmacy benefits managers providing claims processing services or other prescription drug or device services for health benefit plans. (b) The purpose of this chapter is to: (1) Promote, preserve, and protect the public health, safety, and welfare […]
Section 27-45A-3 – Definitions.
Section 27-45A-3 Definitions. For purposes of this chapter, the following words shall have the following meanings: (1) CLAIMS PROCESSING SERVICES. The administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include any of the following: a. Receiving payments for pharmacist services. b. Making payments to pharmacists or […]
Section 27-45A-4 – Licensure of Pharmacy Benefits Managers.
Section 27-45A-4 Licensure of pharmacy benefits managers. (a) A person may not establish or operate as a pharmacy benefits manager in this state without first obtaining a license from the commissioner. (b) Effective through December 31, 2021, to initially obtain a license or renew a license, a pharmacy benefits manager shall submit all of the […]
Section 27-45A-5 – Powers of the Commissioner.
Section 27-45A-5 Powers of the commissioner. (a) The commissioner may adopt rules necessary to implement this chapter. (b) The powers and duties set forth in this chapter shall be in addition to all other authority of the commissioner. (c) The commissioner shall enforce compliance with the requirements of this chapter and rules adopted thereunder. (d)(1) […]
Section 27-45A-6 – Construction and Application of Chapter.
Section 27-45A-6 Construction and application of chapter. (a) Nothing in this chapter is intended or shall be construed to do any of the following: (1) Be in conflict with existing relevant federal law. (2) Apply to any specialty drug. (3) Impact the ability of a hospital to mandate its employees use of a hospital-owned pharmacy. […]
Section 27-45A-7
Section 27-45A-7 Reserved.
Section 27-45A-8 – Pharmacy Benefits Managers – Prohibited Activities Related to Covered Individuals.
Section 27-45A-8 Pharmacy benefits managers – Prohibited activities related to covered individuals. A pharmacy benefits manager may not do any of the following: (1) Require a covered individual, as a condition of payment or reimbursement, to purchase pharmacist services, including, but not limited to, prescription drugs, exclusively through a mail-order pharmacy or pharmacy benefits manager […]
Section 27-45A-9 – Annual Report.
Section 27-45A-9 Annual report. (a) For purposes of this section, client means a health insurer, payor, or health benefit plan. (b) If requested by a client under subsection (d), a pharmacy benefits manager shall prepare an annual report by June 1 which discloses all of the following with respect to that client: (1) The aggregate […]