Title 26 — Title 26 — Insurance Code
56 chapters · 1,242 sections in this title.
W.S. § 26-52-101 Licensure of pharmacy benefit managers
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Licensure of pharmacy benefit managers. No person shall act or hold himself out as a pharmacy benefit manager in this state unless he obtains a license from the department. The department shall through rules establish license requirements and procedures for the licensing of pharm…
W.S. § 26-52-102 (a) Definitions
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(a) Definitions. As used in this article: (i) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device; (ii) "Insurer" means the entity defined in W.S. 26-1102…
W.S. § 26-52-103 Pharmacy benefit manager audits
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Pharmacy benefit manager audits. (a) Any pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager who conducts an audit of a pharmacy shall follow the following procedures: (i) Provide written notice to the pharmacy not less than ten (10) business days be…
W.S. § 26-52-104 Maximum allowable cost; offering information and alternatives
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Maximum allowable cost; offering information and alternatives. (a) To place a drug on a maximum allowable cost list, a pharmacy benefit manager shall ensure that the drug is: (i) If the drug is a generically equivalent drug, rated "A" or "B" in the most recent version of the Unit…
W.S. § 26-52-105 Transparency; prohibitions
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Transparency; prohibitions. (a) A pharmacy benefit manager or an agent of a pharmacy benefit manager shall not: (i) Cause or knowingly permit the use of an advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading; (ii) Char…
W.S. § 26-52-106 Alternate reimbursement methodologies
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Alternate reimbursement methodologies. All contracts between a pharmacy benefits manager and a pharmacy services administrative organization, or its contracted pharmacies, and all contracts directly between a pharmacy benefits manager and a pharmacy shall include a process to inv…
W.S. § 26-52-107 Certain claims excluded
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Certain claims excluded. W.S. 26-52-104 through 26-52-106 shall apply to all health benefit plan issuers and pharmacy benefit managers except those claims associated with the Wyoming Medicaid fee-for-service program, the Wyoming workers compensation division or those claims other…
W.S. § 26-52-201 Scope and applicability of chapter
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Scope and applicability of chapter. The following provisions apply to situations where there is a contract between an insurer or the insurer's intermediary and a pharmacy regarding the payment of insurance claims for pharmacy services pursuant to W.S. 26-52-102(a)(ix) submitted t…
W.S. § 26-52-202 (a) Definitions
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(a) Definitions. As used in this chapter: (i) "Applicable number of calendar days" means: (A) For claims submitted electronically, twenty- one (21) days; (B) For claims submitted in a manner other than electronically, thirty (30) days. (ii) "Clean claim" means a claim that has no…
W.S. § 26-52-203 Payment of claims to pharmacy providers
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Payment of claims to pharmacy providers. (a) A contract between an insurer or the insurer's intermediary and a pharmacy for prescription drug coverage offered by the insurer or the insurer's intermediary shall require the insurer or the insurer's intermediary to make payment to t…