Title 31A, Title 31A: Insurance Code

31A-46-202. Application for licensure. (1) To obtain or renew a license as a pharmacy benefit manager, a person shall: submit an application to the commissioner on forms and in a manner established by the commissioner by rule made in accordance with; and Title 63G, Chapter 3, Uta…

31A-46-301. Reporting requirements. (1) Before April 1 of each year, a pharmacy benefit manager operating in the state shall report to the department, for the previous calendar year: any insurer, pharmacy, or pharmacist in the state with which the pharmacy benefit manager had a c…

31A-46-302. Direct or indirect remuneration by pharmacy benefit managers -- Disclosure of customer costs -- Limit on customer payment for prescription drugs. (1) If a pharmacy service entity engages in direct or indirect remuneration with a pharmacy, the pharmacy service entity s…

31A-46-303. Insurer and pharmacy benefit management services -- Registration -- Maximum allowable cost -- Audit restrictions. (1) An insurer and an insurer's pharmacy benefit manager is subject to the pharmacy audit provisions of Section. 58-17b-622 (2) A pharmacy benefit manager…

31A-46-304. Claims practices. (1) A pharmacy benefit manager shall permit a pharmacy to collect the amount of a customer's cost share from any source. (2) A pharmacy benefit manager may not deny or reduce a reimbursement to a pharmacy or a pharmacist after the adjudication of the…

31A-46-305. Pharmacy reimbursement. A pharmacy benefit manager shall reimburse a network pharmacy, in the aggregate, in an amount no less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benefit manager in the same network, in the aggregat…

31A-46-306. Mailing or delivering prescription drugs. A pharmacy benefit manager or an insurer may not, directly or indirectly: (1) prohibit an in-network retail pharmacy from: mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network reta…

31A-46-307. Pharmacy benefit manager reporting. (1) A pharmacy benefit manager may not enter into or renew a contract with an insurer on or after January 1, 2021, to administer or manage rebate contracting or rebate administration unless the pharmacy benefit manager agrees to reg…

31A-46-308. Out-of-state mail service pharmacies -- Drugs not readily available in all pharmacies. (1) As used in this section, "out-of-state mail service pharmacy" means the same as that term is defined in Section. 58-17b-102 (2) Except as provided in Subsection, a third party p…

31A-46-309. Reimbursement -- Prohibitions. (1) This section applies to a contract entered into or renewed on or after January 1, 2021, between a pharmacy benefit manager and a pharmacy. (2) A pharmacy benefit manager may not vary the amount it reimburses a pharmacy for a drug on …

31A-46-310. Prohibited actions with respect to a federally qualified health center. (1) As used in this section, "federally qualified health center": means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and includes the pharmacy or pharmacies that are operated b…

31A-46-311. Prohibited actions with respect to the 340B drug discount program. (1) As used in this section: "340B covered entity" means the same as the term "covered entity" is defined in 42 U.S.C. Sec. 256b(a)(4). "340B eligible drug" means a drug purchased through the 340B drug…

31A-46-312. Options for self-funded health benefit plans. A pharmacy benefit manager shall offer to a self-funded health benefit plan, as an option for the self-funded health benefit plan's design, pharmacy benefit management services that: (1) comply with the provisions of Subse…

31A-46-401. Penalties. (1) The commissioner may order a pharmacy benefit manager who violates this chapter to forfeit to the state not more than $2,500 for each violation. (2) Each day the violation continues is a separate violation.

31A-46-402. Severability. If any provision of this chapter or the application of any provision of this chapter is found invalid, the remainder of this chapter shall be given effect without the invalid provision or application.