§1869. Compensation program; review by commissioner; exceptions
A. The commissioner may review the compensation program of a pharmacy benefit
manager or person acting on behalf of a pharmacy benefit manager with a health insurance
issuer, pharmacy services administrative organization, pharmacy, or pharmacist, or any
person acting on their behalf, to ensure that the reimbursement for drugs, devices, and
services paid to the pharmacist or pharmacy is fair and reasonable.
B. "Compensation program" means both of the following:
(1)Negotiated price concessions such as base price concessions, including those
labeled as a rebate or otherwise; reasonable estimates of any price protection rebates; and
performance-based price concessions that may accrue directly or indirectly to the health
insurance
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§1869. Compensation program; review by commissioner; exceptions
A. The commissioner may review the compensation program of a pharmacy benefit
manager or person acting on behalf of a pharmacy benefit manager with a health insurance
issuer, pharmacy services administrative organization, pharmacy, or pharmacist, or any
person acting on their behalf, to ensure that the reimbursement for drugs, devices, and
services paid to the pharmacist or pharmacy is fair and reasonable.
B. "Compensation program" means both of the following:
(1) Negotiated price concessions such as base price concessions, including those
labeled as a rebate or otherwise; reasonable estimates of any price protection rebates; and
performance-based price concessions that may accrue directly or indirectly to the health
insurance issuer, plan, or other party on behalf of the health insurance issuer or plan,
including a pharmacy benefit manager, during the coverage year. These concessions may
come from a pharmaceutical manufacturer, dispensing pharmacy, or other party in
connection with the dispensing or administration of a prescription drug.
(2) Reasonable estimates, as determined by the commissioner, of any negotiated
price concessions, fees, and other administrative costs that are passed through, or are
reasonably anticipated to be passed through, to the health insurance issuer or plan that serve
to reduce the health insurance issuer's or plan's liabilities for a prescription drug.
C. Information provided to the commissioner pursuant to Subsection A of this
Section and specifically identified as confidential by the pharmacy benefit manager,
including the terms and conditions of any contract and other proprietary information, shall
be confidential and shall not be subject to disclosure. However, the commissioner may
disclose confidential information to insurance departments of other states or for the purposes
of any adjudicatory hearing or court proceeding invoked by the commissioner in accordance
with the provisions of this Part.