§ 4-88-803 — Required practices

(a) A PBM, when seeking payment or reimbursement for pharmacist services provided in connection with a pharmacy benefits plan or program or reporting expenditures for pharmacist services provided in connection with a pharmacy benefits plan or program, shall itemize by individual claim: (1) The amount actually paid or to be paid to the pharmacy or pharmacist for the pharmacist services; (2) The identity of the pharmacy or pharmacist actually paid or to be paid; and (3) The prescription number or other identifier of the pharmacist services. (b) A PBM shall pay the amounts it receives for pharmacist services provided in connection with a pharmacy benefits plan or program to the pharmacies or pharmacists that provided the pharmacist services. (c) This section does not: (1) Require a PBM to set specific fees, rates, or schedules for payment for pharmacist services; (2) Prohibit a PBM from charging for any services in addition to pharmacist services; or (3) Require a PBM to pay a pharmacy or pharmacist more on any claim than the amount disclosed under subdivision (a)(1) of this section. (d) (1) Unless otherwise required more frequently by the Insurance Commissioner, a pharmacy benefits manager shall file an annual report with the commissioner providing the information required under subsection (a) of this section pursuant to the timing, format, and requirements issued by rule of the State Insurance Department. (2) The annual report is: (A) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207 ; and (B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq. (3) This section is not subject to § 4-88-113(f)(1)(B) .

Legislative History

Amended by Act 2018EX2, No. 3,§ 2, eff. 3/19/2018. Amended by Act 2018EX2, No. 1,§ 2, eff. 3/15/2018. Acts 2009, No. 769, § 1.