Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL 36-11-46.2
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Source: SL 2004, ch 311 , § 8; SL 2023, ch 166 , § 9.
Source: SL 2004, ch 311 , § 1; SL 2023, ch 166 , § 1; SL 2024, ch 203 , § 2, eff
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Jan. 1, 2025.
SDCL § 58-29E-1 Definitions
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Terms used in this chapter mean: (1) "Brand name," the same as set forth in § 36-11-2 ; (2) "Covered individual," a member, participant, enrollee, contract holder, policy holder, or beneficiary of a third-party payor who is provided health coverage by the third-party payor. The t…
SDCL § 58-29E-10 Enforcement of chapter--Civil action
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A third-party payor, 340B entity, or a pharmacy, may bring a civil action to enforce this chapter, including injunctive relief, and seek civil damages for a violation of this chapter. Source: SL 2004, ch 311 , § 10; SL 2023, ch 166 , § 11; SL 2024, ch 203 , § 3, eff. Jan. 1, 2025…
SDCL § 58-29E-11 Repealed
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Source: SL 2004, ch 311 , § 11; SL 2023, ch 166 , § 20.
SDCL § 58-29E-12 Charging cost share that exceeds amount retained by pharmacy--Prohibition
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A pharmacy benefit manager may not contractually require a pharmacy that is a participating provider in a health benefit plan provided by a third-party payor, from charging a covered individual or collecting from a covered individual a cost share for a prescription drug or pharma…
SDCL § 58-29E-13 Certain claims adjustments prohibited
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A pharmacy benefit manager may not, directly or indirectly, retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless: (1) The adjustment is necessitated by a pharmacy audit conducted in accordance with chapter 58-29F ; (2) The adjustm…
SDCL § 58-29E-14 Adjustment of claim due to error in adjudication permitted
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Nothing in §§ 58-29E-12 to 58-29E-15 , inclusive, shall prohibit a pharmacy benefit manager from adjusting claim payment for the benefit of a covered individual if there was an error in the adjudication of a claim submitted by or on behalf of the covered individual. Source: SL 20…
SDCL § 58-29E-15.1 Discrimination prohibited--Treble damages
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A pharmacy benefit manager or a pharmacy benefit manager affiliate who has engaged in a discriminatory act, as prohibited in § 58-29E-15 , is liable to the 340B entity for damages, including actual and consequential damages, and is liable for reasonable attorneys' fees and costs.…
SDCL § 58-29E-16 Prohibition regarding the assessment or collection of fees
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A pharmacy benefit manager may not assess, charge, or collect, from a pharmacy or pharmacist, any remuneration or fee, including: (1) An accreditation fee; (2) A brand effective rate fee; (3) A claim processing fee; (4) A credentialing fee; (5) A dispensing fee; (6) An effective …
SDCL § 58-29E-17 Placement on a maximum allowable cost list--Requirements--Promulgation of rules
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Prior to placing a prescription drug on a maximum allowable cost list, a pharmacy benefit manager shall ensure that the prescription drug is: (1) Listed as therapeutically and pharmaceutically equivalent in the latest edition of, or any supplement to, the Food and Drug Administra…
SDCL § 58-29E-18 Duties--Pharmacy benefit manager
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A pharmacy benefit manager shall: (1) Provide each pharmacy in a pharmacy network with reasonable access to each maximum allowable cost list to which the pharmacy is subject; (2) Update a maximum allowable cost list, within seven calendar days from the date of any increase, at or…
SDCL § 58-29E-19 Reimbursement
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A pharmacy benefit manager may not reimburse any pharmacy located in this state an amount that is less than that which the pharmacy benefit manager reimburses a pharmacy benefit manager affiliate for dispensing the same prescription drug as that dispensed by the pharmacy. The rei…
SDCL § 58-29E-2 Licensure requirement--Pharmacy benefit manager
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A person may not act as a pharmacy benefit manager in this state without a license to operate as a third party administrator pursuant to chapter 58-29D . Sections 58-29D -26, 58-29D -27, and 58-29D -29 do not apply to pharmacy benefits managers. Source: SL 2004, ch 311 , § 2; SL …
SDCL § 58-29E-20 Information to be disclosed--Division request
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A pharmacy benefit manager licensed under this chapter shall, at the request of the Division of Insurance, provide: (1) The amount charged or claimed by the pharmacy benefit manager, in a format that allows the division to identify all instances of spread pricing; and (2) Informa…
SDCL § 58-29E-21 Licensure--Denial--Failure to provide information
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In addition to any grounds set forth in § 58-29D-31 , the director may deny a pharmacy benefit manager's application for an initial or a renewed license, and may suspend or revoke a pharmacy benefit manager's license, if the director determines that the pharmacy benefit manager, …
SDCL § 58-29E-3 Performance of duties--Good faith
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Each pharmacy benefit manager shall perform its duties in good faith and with fair dealing toward the third-party payor. Source: SL 2004, ch 311 , § 3; SL 2023, ch 166 , § 3.
SDCL § 58-29E-4 Request for disclosure of rebates and other revenues
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A third-party payor may request that a pharmacy benefit manager, with which it has a pharmacy benefit management services contract, disclose to the third-party payor the amount of all rebate revenues and the nature, type, and amounts of all other revenues that the pharmacy benefi…
SDCL § 58-29E-5 Permission to contact covered individual
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A pharmacy benefit manager, unless authorized pursuant to the terms of its contract with a third-party payor, may not contact any covered individual, without the express written permission of the third-party payor. Source: SL 2004, ch 311 , § 5; SL 2023, ch 166 , § 5.
SDCL § 58-29E-6 Disclosure of rebates and other revenues--Confidentiality
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Except for utilization information, a third-party payor shall maintain information disclosed in response to a request under § 58-29E-4 as confidential and proprietary information, and may not use that information for any other purpose or disclose that information to any other per…
SDCL § 58-29E-7 Annual audit of pharmacy benefit manager authorized
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A third-party payor that has contracted with a licensed pharmacy benefit manager may audit the pharmacy benefit manager once each calendar year. The audit authorized by this section is in addition to any other statutory or contractual audit rights. As part of the audit, a third-p…
SDCL § 58-29E-7.1 Prohibition on publication or disclosure of information
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Except as provided in chapter 58-17K , and in accordance with the audit provisions in § 58-29E-7 , a third-party payor that has contracted with a licensed pharmacy benefit manager may not publish, or directly or indirectly disclose: (1) Any information that reveals the identity o…
SDCL § 58-29E-8 Substitute drug--Dispensation
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A pharmacy benefit manager may request that a lower - priced generic and therapeutically equivalent prescription drug be dispensed to a covered individual, as a substitute for a higher - priced prescription drug. If the substitute prescription drug's net cost is higher for the co…
SDCL § 58-29E-8.1 Provision of information to a patient
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A pharmacy benefit manager may neither prohibit a pharmacist or pharmacy from, nor penalize a pharmacist or pharmacy for, informing a covered individual about: (1) The cost of a prescription drug; (2) The amount of reimbursement that the pharmacy will receive for dispensing the p…
SDCL § 58-29E-9 Rules--Content
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The Division of Insurance shall promulgate rules, pursuant to chapter 1-26 , to carry out the issuance of the license required by § 58-29E-2 and the enforcement provisions of this chapter. The rules may include the following: (1) Definition of terms; (2) Use of prescribed forms; …