Title 24-A, Title 24-A

A carrier, or a pharmacy benefits manager under contract with a carrier, may not reimburse a pharmacy provider for a prescription drug or pharmacy service in an amount that is less than the reimbursement amount paid to a pharmacy provider affiliated with the carrier or pharmacy b…

1. Prescription drug data. Within 30 business days of a request from a plan sponsor that has certified its compliance with the use and disclosure requirements of 45 Code of Federal Regulations, Section 164.504(f), a pharmacy benefits manager shall provide data to the plan sponsor…

1. Single maximum allowable cost list. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use a single maximum allowable cost list to establish the maximum amount to be paid by a health plan to a pharmacy provider for a generic drug or a brand‑name dru…

1. Compensation used to reduce point-of-sale costs, improve benefits or lower premiums. All compensation remitted by or on behalf of a pharmaceutical manufacturer, developer or labeler, directly or indirectly, to a carrier, or to a pharmacy benefits manager under contract with a …

1. Pharmacy and therapeutics committee; use of formulary. A carrier, or a pharmacy benefits manager under contract with a carrier, shall establish a pharmacy and therapeutics committee. A carrier shall require its pharmacy and therapeutics committee or the pharmacy and therapeuti…

1. Requirements; record keeping. A carrier shall maintain and have the ability to access all data related to the administration and provision of prescription drug benefits under a health plan of a carrier, including, but not limited to: A. The names, addresses, member identificat…

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Anticipated loss ratio" means the ratio of the present value of the future benefits payments to the present value of the future premiums of a poli…

This chapter takes effect January 1, 2020.

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Pharmacy benefits management fee" means a fee that covers the cost of providing one or more pharmacy benefits manager services, as described in se…