§ 20-3332 — Prohibition against claim adjudication process fees; civil remedies

A. A pharmacy benefit manager may not directly or indirectly, on behalf of itself, a plan sponsor or an insurer, charge or hold a pharmacist or pharmacy responsible for a fee for any step of or component or mechanism related to the claims adjudication process, including:

1. Adjudicating a pharmacy benefit claim.

2. Processing or transmitting a pharmacy benefit claim.

3. Developing or managing a claims processing or adjudication network.

4. Participating in a claims processing or adjudication network.

B. A pharmacy may submit a complaint of a violation of this chapter to the director. The pharmacy must include supporting documentation at the time the pharmacy files the complaint. The director shall investigate the complaint and may examine and audit the books and records of a pharmacy benefit manager to determine if the pharmacy benefit manager has committed a violation of this chapter. If the director finds that a pharmacy benefit manager has committed a violation of this chapter, the director may:

1. Seek an injunction in a court of competent jurisdiction and may apply for temporary and permanent orders that the director determines are necessary to restrain the pharmacy benefit manager from continuing to commit the violation.

2. Issue a cease and desist order pursuant to section 20-456 on the pharmacy benefit manager.

C. A pharmacy benefit manager that commits a violation of this chapter is subject to the penalties prescribed in section 20-456.

D. In addition to the actions and penalties prescribed in subsections B and C of this section, any person who is damaged by the acts of a pharmacy benefit manager committed in violation of this chapter may bring a civil action for damages against the pharmacy benefit manager committing the violation in a court of competent jurisdiction.