(a) The Insurance Commissioner shall enforce this subchapter.
(b) (1) The commissioner may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a health benefit plan to determine if the pharmacy benefits manager is in compliance with this subchapter.(2) The information or data acquired during an examination under subdivision (b)(1) of this section is:(A) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(1) The commissioner may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a health benefit plan to determine if the pharmacy benefits manager is in compliance with this subchapter.
(2) The information or data acquired during an examination under subdivision (b)(1) of this section is:(A) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(A) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and
(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(c) After notice and opportunity for hearing, the commissioner may:(1) Impose a penalty of up to five thousand dollars ($5,000) per violation against a pharmacy benefits manager if the commissioner finds that the pharmacy benefits manager has not:(A) Followed the process established for determining pricing or costs under the Maximum Allowable Cost List under § 17-92-507;(B) Used the national average drug acquisition cost under § 23-92-506(b); or(C) Complied with the requirements of this subchapter;(2) Revoke, place on probation, or suspend the license of a pharmacy benefits manager or revoke, place on probation, or suspend the use of a specific network used by a pharmacy benefits manager and identified by a registered unique combination for pharmacy claims if the commissioner finds that the pharmacy benefits manager:(A) Has committed a pattern of violations of this subchapter;(B) Has not followed the process established for determining pricing and costs under the Maximum Allowable Cost List under § 17-92-507;(C) Has not used the national average drug acquisition cost under § 23-92-506(b); or(D) Has violated this subchapter; and(3) For a pattern of more than two (2) violations of this subchapter, revoke or prohibit a pharmacy benefits manager for up to three (3) years from bidding on new business opportunities with a plan or program that is directly or indirectly funded by a state appropriation to furnish, cover the cost of, or otherwise provide for pharmacist services to an individual who resides in or is employed in this state.
(1) Impose a penalty of up to five thousand dollars ($5,000) per violation against a pharmacy benefits manager if the commissioner finds that the pharmacy benefits manager has not:(A) Followed the process established for determining pricing or costs under the Maximum Allowable Cost List under § 17-92-507;(B) Used the national average drug acquisition cost under § 23-92-506(b); or(C) Complied with the requirements of this subchapter;
(A) Followed the process established for determining pricing or costs under the Maximum Allowable Cost List under § 17-92-507;
(B) Used the national average drug acquisition cost under § 23-92-506(b); or
(C) Complied with the requirements of this subchapter;
(2) Revoke, place on probation, or suspend the license of a pharmacy benefits manager or revoke, place on probation, or suspend the use of a specific network used by a pharmacy benefits manager and identified by a registered unique combination for pharmacy claims if the commissioner finds that the pharmacy benefits manager:(A) Has committed a pattern of violations of this subchapter;(B) Has not followed the process established for determining pricing and costs under the Maximum Allowable Cost List under § 17-92-507;(C) Has not used the national average drug acquisition cost under § 23-92-506(b); or(D) Has violated this subchapter; and
(A) Has committed a pattern of violations of this subchapter;
(B) Has not followed the process established for determining pricing and costs under the Maximum Allowable Cost List under § 17-92-507;
(C) Has not used the national average drug acquisition cost under § 23-92-506(b); or
(D) Has violated this subchapter; and
(3) For a pattern of more than two (2) violations of this subchapter, revoke or prohibit a pharmacy benefits manager for up to three (3) years from bidding on new business opportunities with a plan or program that is directly or indirectly funded by a state appropriation to furnish, cover the cost of, or otherwise provide for pharmacist services to an individual who resides in or is employed in this state.
(d) (1) The commissioner shall require a pharmacy benefits manager that has an underpayment violation to:(A) Pay twelve percent (12%) interest per month as a penalty to the impacted pharmacy or pharmacist for pharmacist services on an underpayment violation that is calculated on the number of days after the claim was adjudicated until resolution of the underpayment violation; and(B) Pay the entire amount of the amount of the underpayment violation plus the required interest under subdivision (d)(1)(A) of this section to the impacted pharmacy or pharmacist for pharmacist services on an underpayment violation.(2) A pharmacy or pharmacist shall not be required to collect an amount of an underpayment violation or interest from a patient in the form of copay or out-of-pocket expense to the patient.
(1) The commissioner shall require a pharmacy benefits manager that has an underpayment violation to:(A) Pay twelve percent (12%) interest per month as a penalty to the impacted pharmacy or pharmacist for pharmacist services on an underpayment violation that is calculated on the number of days after the claim was adjudicated until resolution of the underpayment violation; and(B) Pay the entire amount of the amount of the underpayment violation plus the required interest under subdivision (d)(1)(A) of this section to the impacted pharmacy or pharmacist for pharmacist services on an underpayment violation.
(A) Pay twelve percent (12%) interest per month as a penalty to the impacted pharmacy or pharmacist for pharmacist services on an underpayment violation that is calculated on the number of days after the claim was adjudicated until resolution of the underpayment violation; and
(B) Pay the entire amount of the amount of the underpayment violation plus the required interest under subdivision (d)(1)(A) of this section to the impacted pharmacy or pharmacist for pharmacist services on an underpayment violation.
(2) A pharmacy or pharmacist shall not be required to collect an amount of an underpayment violation or interest from a patient in the form of copay or out-of-pocket expense to the patient.