(1) As used in this subchapter:(1) (A) “Administrative services” means a service provided by a pharmacy services administrative organization.(B) “Administrative services” includes without limitation:(i) Assistance with a claim;(ii) Assistance with an audit;(iii) Assistance with access to a pharmacy network;(iv) Assistance with interactions between a pharmacy and a pharmacy benefits manager;(v) Centralized payment;(vi) Certification in a specialized care program;(vii) Compliance support;(viii) Setting a flat fee for generic drugs;(ix) Assistance with store layout;(x) Marketing support;(xi) Management and analysis of payment and drug dispensing data; or(xii) Provision of resources for a retail cash card;(2) “Pharmacy benefits manager” means a person or an entity operating within this state that contracts with a health benefit plan, an employer, or a union to administer or manage prescription drug benefits on behalf of a healthcare insurer that provides prescription drug benefits;(3) (A) “Pharmacy services administrative organization” means an entity operating within this state that contracts with one (1) or more pharmacies to conduct business on their behalf with a third-party payer.(B) “Pharmacy services administrative organization” includes a person or entity that performs one (1) or more administrative services on behalf of one (1) or more pharmacies and negotiates and enters a contract with a third-party payer or pharmacy benefits manager on behalf of a pharmacy;(4) “Pharmacy services administrative organization-pharmacy contract” means a contractual agreement between a pharmacy services administrative organization and a pharmacy by which a pharmacy services administrative organization agrees to negotiate with a third-party payer on behalf of a pharmacy and to provide other services as stated in the pharmacy services administrative organization-pharmacy contract; and(5) (A) “Third-party payer” means an organization operating within this state that pays or insures health, medical, or prescription drug expenses on behalf of beneficiaries.(B) “Third-party payer” includes a:(i) Plan sponsor;(ii) Healthcare service plan;(iii) Health maintenance organization; or(iv) Healthcare insurer.(C) “Third-party payer” does not include a nonfederal governmental plan as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025.
(1) (A) “Administrative services” means a service provided by a pharmacy services administrative organization.(B) “Administrative services” includes without limitation:(i) Assistance with a claim;(ii) Assistance with an audit;(iii) Assistance with access to a pharmacy network;(iv) Assistance with interactions between a pharmacy and a pharmacy benefits manager;(v) Centralized payment;(vi) Certification in a specialized care program;(vii) Compliance support;(viii) Setting a flat fee for generic drugs;(ix) Assistance with store layout;(x) Marketing support;(xi) Management and analysis of payment and drug dispensing data; or(xii) Provision of resources for a retail cash card;
(A) “Administrative services” means a service provided by a pharmacy services administrative organization.
(B) “Administrative services” includes without limitation:(i) Assistance with a claim;(ii) Assistance with an audit;(iii) Assistance with access to a pharmacy network;(iv) Assistance with interactions between a pharmacy and a pharmacy benefits manager;(v) Centralized payment;(vi) Certification in a specialized care program;(vii) Compliance support;(viii) Setting a flat fee for generic drugs;(ix) Assistance with store layout;(x) Marketing support;(xi) Management and analysis of payment and drug dispensing data; or(xii) Provision of resources for a retail cash card;
(i) Assistance with a claim;
(ii) Assistance with an audit;
(iii) Assistance with access to a pharmacy network;
(iv) Assistance with interactions between a pharmacy and a pharmacy benefits manager;
(v) Centralized payment;
(vi) Certification in a specialized care program;
(vii) Compliance support;
(viii) Setting a flat fee for generic drugs;
(ix) Assistance with store layout;
(x) Marketing support;
(xi) Management and analysis of payment and drug dispensing data; or
(xii) Provision of resources for a retail cash card;
(2) “Pharmacy benefits manager” means a person or an entity operating within this state that contracts with a health benefit plan, an employer, or a union to administer or manage prescription drug benefits on behalf of a healthcare insurer that provides prescription drug benefits;
(3) (A) “Pharmacy services administrative organization” means an entity operating within this state that contracts with one (1) or more pharmacies to conduct business on their behalf with a third-party payer.(B) “Pharmacy services administrative organization” includes a person or entity that performs one (1) or more administrative services on behalf of one (1) or more pharmacies and negotiates and enters a contract with a third-party payer or pharmacy benefits manager on behalf of a pharmacy;
(A) “Pharmacy services administrative organization” means an entity operating within this state that contracts with one (1) or more pharmacies to conduct business on their behalf with a third-party payer.
(B) “Pharmacy services administrative organization” includes a person or entity that performs one (1) or more administrative services on behalf of one (1) or more pharmacies and negotiates and enters a contract with a third-party payer or pharmacy benefits manager on behalf of a pharmacy;
(4) “Pharmacy services administrative organization-pharmacy contract” means a contractual agreement between a pharmacy services administrative organization and a pharmacy by which a pharmacy services administrative organization agrees to negotiate with a third-party payer on behalf of a pharmacy and to provide other services as stated in the pharmacy services administrative organization-pharmacy contract; and
(5) (A) “Third-party payer” means an organization operating within this state that pays or insures health, medical, or prescription drug expenses on behalf of beneficiaries.(B) “Third-party payer” includes a:(i) Plan sponsor;(ii) Healthcare service plan;(iii) Health maintenance organization; or(iv) Healthcare insurer.(C) “Third-party payer” does not include a nonfederal governmental plan as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025.
(A) “Third-party payer” means an organization operating within this state that pays or insures health, medical, or prescription drug expenses on behalf of beneficiaries.
(B) “Third-party payer” includes a:(i) Plan sponsor;(ii) Healthcare service plan;(iii) Health maintenance organization; or(iv) Healthcare insurer.
(i) Plan sponsor;
(ii) Healthcare service plan;
(iii) Health maintenance organization; or
(iv) Healthcare insurer.
(C) “Third-party payer” does not include a nonfederal governmental plan as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025.