(a)An enrollee's defined cost sharing for a prescription drug shall be calculated at the point-of-sale based on a price that is reduced by an amount equal to at least one hundred percent (100%) of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.
(b)This subchapter shall not preclude a pharmacy benefits manager from decreasing an enrollee's defined cost sharing by an amount greater than that required under subsection (a) of this section.
(c)(1) A pharmacy benefits manager shall submit a certification to the Insurance Commissioner by January 1 of each calendar year certifying that the pharmacy benefits manager has complied with the requirements of this section during the previous calendar year.
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(a) An enrollee's defined cost sharing for a prescription drug shall be calculated at the point-of-sale based on a price that is reduced by an amount equal to at least one hundred percent (100%) of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug. (b) This subchapter shall not preclude a pharmacy benefits manager from decreasing an enrollee's defined cost sharing by an amount greater than that required under subsection (a) of this section. (c) (1) A pharmacy benefits manager shall submit a certification to the Insurance Commissioner by January 1 of each calendar year certifying that the pharmacy benefits manager has complied with the requirements of this section during the previous calendar year. (2) The certification under subdivision (c)(1) of this section shall be signed by the chief executive officer or chief financial officer of the pharmacy benefits manager. (3) The form of the certification shall: (A) Be in a format approved or established by the commissioner; and (B) Include the pharmacy benefits manager's best estimate of the aggregate amount of rebates used to reduce enrollee-defined cost sharing for prescription drugs in the previous calendar year based on information known to the pharmacy benefits manager as of the date of the certification. (d) (1) In complying with this section, a pharmacy benefits manager or its agents shall not publish or otherwise reveal information regarding the actual amount of rebates a pharmacy benefits manager receives on a product or therapeutic class of products, manufacturer, or pharmacy-specific basis. (2) The information described in subdivision (d)(1) of this section is: (A) Protected as a trade secret; (B) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207 ; (C) Not subject to disclosure under the Freedom of Information Act of 1967, § 25-19-101 et seq.; and (D) Not to be disclosed: (i) Directly or indirectly; or (ii) In a manner that would: (a) Allow for the identification of an individual product, therapeutic class of products, or manufacturer; or (b) Have the potential to compromise the financial, competitive, or proprietary nature of the information. (3) A pharmacy benefits manager shall impose the confidentiality protections of this section on any vendor or downstream third party that performs healthcare services or administrative services on behalf of the pharmacy benefits manager that may receive or have access to rebate information.