(a) A pharmacy services administrative organization-pharmacy contract shall provide that if there is a dispute between a pharmacy and a pharmacy benefits manager or a third-party payer, the pharmacy services administrative organization shall ensure and facilitate timely communication from the pharmacy to the pharmacy benefits manager or the third-party payer.
(b) A pharmacy services administrative organization-pharmacy contract shall provide that the pharmacy services administrative organization shall forward a notice of appeal from a pharmacy to the pharmacy benefits manager or the third-party payer in a timely manner.
(c) If an appeal does not meet the minimum requirements described in the pharmacy services administrative organization-pharmacy contract, the pharmacy services administrative organization shall:(1) Provide the pharmacy with the reason for the denial of the appeal; and(2) Allow the pharmacy to resubmit the appeal for a review by a pharmacy benefits manager.
(1) Provide the pharmacy with the reason for the denial of the appeal; and
(2) Allow the pharmacy to resubmit the appeal for a review by a pharmacy benefits manager.
(d) In connection with an appeal or similar process under § 17-92-507, a third-party payer's or pharmacy benefits manager's notice or provision of information to a pharmacy services administrative organization is deemed to be notice or provision of information to the pharmacy on whose behalf the pharmacy services administrative organization has contracted.