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Delaware Statutes, Title 18

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Delaware/Statutes

← All Delaware coverage

Title 18, Insurance Code

84 chapters · 1,726 sections in this title.

All chapters in Title 181,726 Ch 35, GROUP AND BLANKET HEALTH INSURANCE124 Ch 33, HEALTH INSURANCE CONTRACTS109 Ch 69, CAPTIVE INSURANCE COMPANIES55 Ch 49, Organization and Corporate Powers; P…46 Ch 68, HEALTH-CARE MEDICAL NEGLIGENCE INSUR…43 Ch 29, Life Insurance and Annuity Contracts42 Ch 33a, Pharmacy Benefits Managers [For appl…39 Ch 59, REHABILITATION AND LIQUIDATION38 Ch 62, FRATERNAL BENEFIT SOCIETIES38 Ch 11, ASSETS AND LIABILITIES37 Ch 5, Authorization of Insurers and Genera…36 Ch 41, PROPERTY INSURANCE CONTRACTS36 Ch 19, DELAWARE NONADMITTED INSURANCE ACT35 Ch 25, Rates and Rating Organizations35

39 sections·Filtered byTitle 18✕Ch 33a✕

18 Del. C. § 3301A. Pharmacy Audit Integrity Program [For application of this section, see 80 Del. Laws, c. 245, § 2].
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§ 3301A. Pharmacy Audit Integrity Program [For application of this section, see 80 Del. Laws, c. 245, § 2]. The Pharmacy Audit Integrity Program is established to provide standards for an audit of pharmacy records carried out by a pharmacy benefits manager or any entity that repr…
18 Del. C. § 3302A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2; 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7].
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§ 3302A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2; 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7]. For purposes of this subchapter: (1) “Entity” means a pharmacy benefits manager or any person or organization that represents these compan…
18 Del. C. § 3303A. Pharmacy benefit manager contract [For application of this section, see 80 Del. Laws, c. 245, § 2].
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§ 3303A. Pharmacy benefit manager contract [For application of this section, see 80 Del. Laws, c. 245, § 2]. An amendment to pharmacy audit terms in a contract between a PBM and a pharmacy must be disclosed to the pharmacy at least 60 days prior to the effective date of the propo…
Procedure and process for conducting and reporting an audit [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7].

18 Del. C. § 3304A.

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§ 3304A. Procedure and process for conducting and reporting an audit [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7]. (a) Audit procedures. — Unless otherwise prohibited by federal requirements or regulations, any entity conducting a ph…

18 Del. C. § 3305A. Requirements for recoupment or chargeback [For application of this section, see 80 Del. Laws, c. 245, § 2].

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§ 3305A. Requirements for recoupment or chargeback [For application of this section, see 80 Del. Laws, c. 245, § 2]. For recoupment or chargeback, the following criteria apply: (1) Audit parameters must consider consumer-oriented parameters based on manufacturer listings. (2) The…

18 Del. C. § 3306A. Documentation [For application of this section, see 80 Del. Laws, c. 245, § 2].

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§ 3306A. Documentation [For application of this section, see 80 Del. Laws, c. 245, § 2]. (a) To validate the pharmacy record and delivery, the pharmacy may use authentic and verifiable statements or records including medication administration records of a nursing home, assisted l…

18 Del. C. § 3307A. Appeals process [For application of this section, see 80 Del. Laws, c. 245, § 2].

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§ 3307A. Appeals process [For application of this section, see 80 Del. Laws, c. 245, § 2]. The entity conducting the audit must establish a written appeals process which must include appeals of preliminary reports and final reports.80 Del. Laws, c. 65, § 1; 80 Del. Laws, c. 245, …

18 Del. C. § 3308A. Audit information and reports [For application of this section, see 80 Del. Laws, c. 245, § 2].

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§ 3308A. Audit information and reports [For application of this section, see 80 Del. Laws, c. 245, § 2]. (a) A preliminary audit report must be delivered to the pharmacy within 30 days after the conclusion of the audit. The preliminary audit report shall contain claim level infor…

18 Del. C. § 3309A. Disclosures to plan sponsor [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7].

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§ 3309A. Disclosures to plan sponsor [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7]. Where contractually required, an auditing entity must provide a copy to the plan sponsor of all claims that were included in the audit, and any recoup…

18 Del. C. § 3310A. Applicability of other laws and regulations [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7]

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§ 3310A. Applicability of other laws and regulations [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7] The provisions of this subchapter do not apply to an investigative audit of pharmacy records when any of the following apply: (1) Fraud…

18 Del. C. § 3321A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7]

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§ 3321A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2; 85 Del. Laws, c. 481, § 7] For purposes of this subchapter: (1) “Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a d…

18 Del. C. § 3322A. Exclusions [For application of this section, see 80 Del. Laws, c. 245, § 2].

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§ 3322A. Exclusions [For application of this section, see 80 Del. Laws, c. 245, § 2]. This subchapter does not apply to the Department of Health and Human Services in the performance of its duties in administering fee-for-service Medicaid under Titles XIX and XXI of the Social Se…

18 Del. C. § 3323A. Requirements for maximum allowable cost pricing [For application of this section, see 80 Del. Laws, c. 245, § 2; and 83 Del. Laws, c. 256, § 15].

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§ 3323A. Requirements for maximum allowable cost pricing [For application of this section, see 80 Del. Laws, c. 245, § 2; and 83 Del. Laws, c. 256, § 15]. (a) To place a drug on a maximum allowable cost list, a pharmacy benefits manager must ensure that the drug meets all of the …

18 Del. C. § 3324A. Appeals [For application of this section, see 80 Del. Laws, c. 245, § 2; 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7].

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§ 3324A. Appeals [For application of this section, see 80 Del. Laws, c. 245, § 2; 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7]. (a) (1) a. A pharmacy benefits manager must establish a process by which a contracted pharmacy can appeal the amount of the provider’s reimbur…

18 Del. C. § 3325A. Reimbursement for and provision of pharmacy goods or services For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3325A. Reimbursement for and provision of pharmacy goods or services For application of this section, see 83 Del. Laws, c. 256, § 15]. (a) For purposes of this section: (1) “Affiliate” means a pharmacy or pharmacist that directly or indirectly, through 1 or more intermediaries,…

18 Del. C. § 3331A. Definitions For application of this section, see 80 Del. Laws, c. 245, § 2; 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7]

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§ 3331A. Definitions For application of this section, see 80 Del. Laws, c. 245, § 2; 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7] For purposes of this subchapter: (1) “Pharmacist” means as defined in § 2502 of Title 24. (2) “Pharmacy” means as defined in § 2502 of Title…

18 Del. C. § 3332A. Permitted disclosures related to prescription drugs [For application of this section, see 81 Del. Laws, c. 378, § 2; and 81 Del. Laws, c. 256, § 15].

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§ 3332A. Permitted disclosures related to prescription drugs [For application of this section, see 81 Del. Laws, c. 378, § 2; and 81 Del. Laws, c. 256, § 15]. A contract between a pharmacy benefits manager and a pharmacy may not prohibit a pharmacy or pharmacist from doing any of…

18 Del. C. § 3333A. Prohibited retaliation due to permitted disclosures [For application of this section, see 85 Del. Laws, c. 481, § 7].

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§ 3333A. Prohibited retaliation due to permitted disclosures [For application of this section, see 85 Del. Laws, c. 481, § 7]. (a) A pharmacy benefits manager may not retaliate against a pharmacist or pharmacy for disclosing information in any proceeding if the pharmacist or phar…

18 Del. C. § 3335A. Definitions [For application of this section, see 85 Del. Laws, c. 481, § 7].

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§ 3335A. Definitions [For application of this section, see 85 Del. Laws, c. 481, § 7]. For purposes of this subchapter: (1) “Chronic or long-term condition” means any of the following: a. A “complex or chronic medical condition” as defined in § 3364(a) of this title. b. A “rare m…

18 Del. C. § 3336A. Prior authorization of emergency prescriptions [For application of this section, see 85 Del. Laws, c 481, § 7].

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§ 3336A. Prior authorization of emergency prescriptions [For application of this section, see 85 Del. Laws, c 481, § 7]. A pharmacy benefits manager may not require prior authorization for coverage of a 72-hour supply of medication that is for a noncontrolled substance prescribed…

18 Del. C. § 3337A. Prior authorization of prescriptions for chronic or long-term conditions [For application of this section, see 85 Del. Laws, c. 481, § 7].

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§ 3337A. Prior authorization of prescriptions for chronic or long-term conditions [For application of this section, see 85 Del. Laws, c. 481, § 7]. (a) A prior authorization form for a prescription medication must include a question regarding whether the prescription medication i…

18 Del. C. § 3351A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3351A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15]. For purposes of this subchapter: (1) “Pharmacy benefits management services” means all of the following: a. The procurement of prescription drugs at a negotiated rate for dispensation within t…

18 Del. C. § 3352A. Applicability.

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§ 3352A. Applicability. This subchapter does not apply to plans of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act, 42 U.S.C. §§ 1395 et seq., 1396 et seq., and 1397aa et seq., …

18 Del. C. § 3353A. Registration required [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3353A. Registration required [For application of this section, see 83 Del. Laws, c. 256, § 15]. (a) A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in this State to a purchase…

18 Del. C. § 3354A. Expiration and renewal of registration [For application of this section, see 83 Del. Laws, c. 256. § 15].

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§ 3354A. Expiration and renewal of registration [For application of this section, see 83 Del. Laws, c. 256. § 15]. (a) A pharmacy benefits manager registration expires on May 1 after its effective date unless it is renewed as provided under this section. (b) A pharmacy benefits m…

18 Del. C. § 3355A. Denial, suspension, or revocation of registration [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3355A. Denial, suspension, or revocation of registration [For application of this section, see 83 Del. Laws, c. 256, § 15]. (a) The Commissioner may deny a registration to a pharmacy benefits manager applicant or refuse to renew, suspend, or revoke the registration of, or issue…

18 Del. C. § 3356A. Recordkeeping requirements.

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§ 3356A. Recordkeeping requirements. A pharmacy benefits manager shall maintain adequate books and records about each purchaser for which the pharmacy benefits manager provides pharmacy benefits management services as follows: (1) In accordance with prudent standards of record ke…

18 Del. C. § 3357A. Examination of affairs, transactions, accounts, and records.

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§ 3357A. Examination of affairs, transactions, accounts, and records. (a) Whenever the Commissioner considers it advisable, the Commissioner may examine the affairs, transactions, accounts, and records of a registered pharmacy benefits manager. (b) The examination must be conduct…

18 Del. C. § 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices.

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§ 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices. A pharmacy benefits manager may not ship, mail, or deliver prescription drugs or devices to a person in this State through a nonresident pharmacy unless the nonresident pharmacy holds a pe…

18 Del. C. § 3359A. Penalties and enforcement [Transferred].

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§ 3359A. Penalties and enforcement [Transferred]. 82 Del. Laws, c. 115, § 4Transferred to § 3373A of this title by 83 Del. Laws, c. 256, § 14, effective Oct. 26, 2021.

18 Del. C. § 3361A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3361A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15]. For purposes of this subchapter: (1) “Claim” means as defined under § 3321A of this title. (2) “Insured” means an individual covered by health insurance offered by an insurer. (3) “Insurer” me…

18 Del. C. § 3362A. Pharmacy benefits manager network [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3362A. Pharmacy benefits manager network [For application of this section, see 83 Del. Laws, c. 256, § 15]. (a) A pharmacy benefits manager shall provide a reasonably adequate and accessible pharmacy benefits manager network for the provision of prescription drugs, which provid…

18 Del. C. § 3363A. Reports [For application of this section, see 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7].

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§ 3363A. Reports [For application of this section, see 83 Del. Laws, c. 256, § 15; 85 Del. Laws, c. 481, § 7]. (a) A pharmacy benefits manager shall provide a pharmacy benefits manager network adequacy report describing the pharmacy benefits manager network and the pharmacy benef…

18 Del. C. § 3371A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3371A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15]. For purposes of this subchapter: (1) “Board of Pharmacy” means the Delaware Board of Pharmacy. (2) “Claim” means as defined under § 3321A of this title. (3) “Insurer” means as defined under § …

18 Del. C. § 3372A. Prohibited practices [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3372A. Prohibited practices [For application of this section, see 83 Del. Laws, c. 256, § 15]. A pharmacy benefits manager or representative of a pharmacy benefits manager may not do any of the following: (1) Engage in spread pricing. (2) Cause or knowingly permit the use of an…

18 Del. C. § 3373A. Penalties and enforcement [For application of this section, see 83 Del. Laws, c. 256, § 15].

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§ 3373A. Penalties and enforcement [For application of this section, see 83 Del. Laws, c. 256, § 15]. (a) If the Commissioner determines that a pharmacy benefits manager has violated any provision of this chapter or any regulation adopted under this chapter, the Commissioner may,…

18 Del. C. § 3374A. Prohibition of discrimination against 340B entities by pharmacy benefits managers.

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§ 3374A. Prohibition of discrimination against 340B entities by pharmacy benefits managers. (a) For purposes of this section: (1) “340B drug” means a drug that is a covered outpatient drug under 42 U.S.C. § 256b. (2) “340B drug program” means the federal drug pricing program unde…

18 Del. C. § 3381A. Definitions [For application of this subchapter, see 83 Del. Laws, c. 522, § 4].

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§ 3381A. Definitions [For application of this subchapter, see 83 Del. Laws, c. 522, § 4]. For purposes of this subchapter: (1) “Cost-sharing requirement” means any copayment, coinsurance, deductible, or annual limitation on cost-sharing (including a limitation subject to 42 U.S.C…

18 Del. C. § 3382A. Fairness in cost-sharing [For application of this subchapter, see 83 Del. Laws, c. 522, § 4].

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§ 3382A. Fairness in cost-sharing [For application of this subchapter, see 83 Del. Laws, c. 522, § 4]. (a) Cost-sharing calculation. — When calculating an enrollee’s contribution to any applicable cost-sharing requirement, a pharmacy benefits manager shall include any cost-sharin…