(a) A prohibition of an activity under this subchapter is applicable to a person or entity that:(1) Performs the prohibited activity;(2) Causes another person or entity to perform the prohibited activity;(3) Solicits, advises, encourages, or coerces another person or entity to perform the prohibited activity;(4) Aids or attempts to aid another person or entity in performing a prohibited activity; or(5) Indirectly performs the prohibited activity.
(1) Performs the prohibited activity;
(2) Causes another person or entity to perform the prohibited activity;
(3) Solicits, advises, encourages, or coerces another person or entity to perform the prohibited activity;
(4) Aids or attempts to aid another person or entity in performing a prohibited activity; or
(5) Indirectly performs the prohibited activity.
(b) (1) This subchapter does not require a self-funded health benefit plan to:(A) Alter existing covered benefits of the self-funded health benefit plan; or(B) Modify underlying plan terms of the self-funded health benefit plan.(2) However, to the extent not preempted by federal law, this section applies to the administration and business practices of pharmacy benefits within the state, including without limitation the conduct of pharmacy benefits managers and pharmacy benefits manager affiliates.
(1) This subchapter does not require a self-funded health benefit plan to:(A) Alter existing covered benefits of the self-funded health benefit plan; or(B) Modify underlying plan terms of the self-funded health benefit plan.
(A) Alter existing covered benefits of the self-funded health benefit plan; or
(B) Modify underlying plan terms of the self-funded health benefit plan.
(2) However, to the extent not preempted by federal law, this section applies to the administration and business practices of pharmacy benefits within the state, including without limitation the conduct of pharmacy benefits managers and pharmacy benefits manager affiliates.
(c) (1) If a pharmacy benefits manager imposes or represents any requirement or limitation as health-benefit-plan-imposed, the actual terms of the underlying health benefit plan document shall control.(2) The health benefit plan sponsor shall retain the authority to interpret and apply the health benefit plan sponsor's own health benefit plan's terms to the extent permitted by applicable federal and state law.
(1) If a pharmacy benefits manager imposes or represents any requirement or limitation as health-benefit-plan-imposed, the actual terms of the underlying health benefit plan document shall control.
(2) The health benefit plan sponsor shall retain the authority to interpret and apply the health benefit plan sponsor's own health benefit plan's terms to the extent permitted by applicable federal and state law.
(d) If it is determined by the Insurance Commissioner that a pharmacy benefits manager or pharmacy benefits manager affiliate is operating outside the terms of the underlying health benefit plan, all dispute, enforcement, and penalties under this subchapter shall apply and may be enforced by the commissioner.