Definitions

As used in the Pharmacy Benefits Manager Regulation Act: A. "maximum allowable cost" means the maximum amount that a pharmacy benefits manager will reimburse a pharmacy for the cost of a generic drug; B. "maximum allowable cost list" means a searchable, electronic and internet-based listing of drugs used by a pharmacy benefits manager setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist is made; C. "obsolete" means a product that is listed in national drug pricing compendia but is no longer available to be dispensed based on the expiration date of the last lot manufactured; D. "pharmacist" means an individual licensed as a pharmacist by the board of pharmacy; E. "pharmacy" means a licensed place of business where drugs are compounded or dispensed and pharmacist services are provided; F. "pharmacy benefits management" means a service provided to or conducted by a health plan as defined in Section 59A-16-21.1 NMSA 1978 or health insurer that involves: (1) prescription drug claim administration; (2) pharmacy network management; (3) negotiation and administration of prescription drug discounts, rebates and other benefits; (4) design, administration or management of prescription drug benefits; (5) formulary management; (6) payment of claims to pharmacies for dispensing prescription drugs; (7) negotiation or administration of contracts relating to pharmacy operations or prescription benefits; or (8) any other service determined by the superintendent as specified by rule to be a pharmacy benefits management activity; G. "pharmacy benefits manager" means an entity that provides pharmacy benefits management services; H. "pharmacy benefits manager affiliate" means a pharmacy or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by or is under common ownership or control with a pharmacy benefits manager; I. "pharmacy services administrative organization" means an entity that contracts with a pharmacy or pharmacist to act as the pharmacy or pharmacist's agent with respect to matters involving a pharmacy benefits manager or third-party payor, including negotiating, executing or administering contracts with the pharmacy benefits manager or third-party payor; and J. "superintendent" means the superintendent of insurance. History: Laws 2014, ch. 14, § 2; 2019, ch. 269, § 1.