§ 22:1864 — Requirements for use of the National Drug Code by a pharmacy benefit manager

§1864. Requirements for use of the National Drug Code by a pharmacy benefit manager
A. Before a pharmacy benefit manager places or continues a particular NDC or
Maximum Allowable Cost List, the following requirements shall be met:
(1) The prescription drug to which the NDC is assigned shall be listed as "A" or "B"
rated in the most recent version of the FDA's Approved Drug Products with Therapeutic
Equivalence Evaluations, also known as the Orange Book, or have an "NR" or "NA" rating
or a similar rating by a nationally recognized reference.
(2) The prescription drug to which the NDC is assigned shall be available for
purchase by pharmacies in the state from national or regional wholesalers.
(3) The prescription drug to which the NDC is assigned shall not be considered
obsolete, temporarily unavailable, or listed on a drug shortage list.
(4) For every drug for which the pharmacy benefit manager establishes a maximum
allowable cost to determine the drug product reimbursement, the pharmacy benefit manager
shall make available to all pharmacies both of the following:
(a) Information identifying the national drug pricing compendia or sources used to
obtain the drug price data.
(b) The comprehensive list of drugs subject to maximum allowable cost by plan and
the actual maximum allowable cost by plan for each drug.
B. A pharmacy benefit manager shall do all of the following:
(1) Provide access to its Maximum Allowable Cost List to each pharmacy subject
to the list.
(2) Update its Maximum Allowable Cost List on a timely basis, but in no event
longer than seven calendar days from a change in the methodology on which the Maximum
Allowable Cost List is based or in the value of a variable involved in the methodology.
(3) Provide a process for each pharmacy subject to the list to review an update to the
Maximum Allowable Cost List.

Legislative History

Acts 2014, No. 391, §1; Acts 2018, No. 597, §1, eff. Jan. 1, 2019.