33-22-177 . (Temporary) Rights of pharmacies.
(1)A pharmacy benefit manager or third-party payer may not prohibit a pharmacist or pharmacy from:
(a)participating in a class-action lawsuit;
(b)disclosing to the plan sponsor or to the patient information regarding the adjudicated reimbursement paid to the pharmacy if the pharmacist or pharmacy complies with the requirements of the federal Health Insurance Portability and Accountability Act of 1996, 29 U.S.C. 1181 et seq.; (c)providing relevant information to a patient about the patient's prescription drug order, including but not limited to the cost and clinical efficacy of a more affordable alternative drug if one is available;
(d)mailing or delivering a prescription drug to a patient as an ancillary service of a pharmacy if the practi
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33-22-177 . (Temporary) Rights of pharmacies. (1) A pharmacy benefit manager or third-party payer may not prohibit a pharmacist or pharmacy from:
(a) participating in a class-action lawsuit;
(b) disclosing to the plan sponsor or to the patient information regarding the adjudicated reimbursement paid to the pharmacy if the pharmacist or pharmacy complies with the requirements of the federal Health Insurance Portability and Accountability Act of 1996, 29 U.S.C. 1181 et seq.;
(c) providing relevant information to a patient about the patient's prescription drug order, including but not limited to the cost and clinical efficacy of a more affordable alternative drug if one is available;
(d) mailing or delivering a prescription drug to a patient as an ancillary service of a pharmacy if the practice is not prohibited under Title 37, chapter 7; or
(e) charging a shipping and handling fee to a patient who has asked that a prescription drug be mailed or delivered if the practice is not prohibited under Title 37, chapter 7.
(2) A pharmacy benefit manager or third-party payer may not:
(a) require pharmacy accreditation standards or recertification requirements inconsistent with, more stringent than, or in addition to federal and state requirements for licensure as a pharmacy in this state; or
(b) exclude a pharmacy from the pharmacy benefit manager's or third-party payer's network based solely on the pharmacy being newly opened or open less than a defined amount of time, or because a license or location transfer occurs, unless there is a pending investigation for fraud, waste, or abuse.
(3) A pharmacist or pharmacy that belongs to a pharmacy services administrative organization may receive a copy of a contract the pharmacy services administrative organization entered into with a pharmacy benefit manager or third-party payer on the pharmacy's or pharmacist's behalf.
(4) A pharmacy benefit manager or third-party payer shall provide a pharmacy or pharmacist with the processor control number, bank identification number, and group number for each pharmacy network established or administered by a pharmacy benefit manager or third-party payer to enable the pharmacy to make an informed contracting decision.
(5) (a) A pharmacy benefit manager shall:
(i) offer a pharmacy or a pharmacy services administrative organization an opportunity to renew an existing contract every 3 years, at a minimum;
(ii) allow a pharmacy or a pharmacy services administrative organization to terminate a contract upon a 90-day notice to the pharmacy benefit manager;
(iii) ensure pharmacy credentialing applications are processed and that pharmacies are added to applicable networks within 45 calendar days after all needed documentation has been submitted by the pharmacy or the pharmacy services administrative organization; and
(iv) ensure pharmacy ownership changes are processed and that the pharmacy can process prescriptions for applicable networks within 30 calendar days after all needed documentation has been submitted by the pharmacy or the pharmacy services administrative organization.
(b) An addendum or amendment to an existing contract between a pharmacy benefit manager and a pharmacy or a pharmacy services administrative organization is effective only upon signing of the addendum or amendment by both parties.
(6) A pharmacy or a pharmacy services administrative organization has a private right of action to enforce provisions of 33-22-175 through 33-22-177 .
(7) Effective rate contracting is prohibited in all agreements between pharmacies or contracting agents acting on behalf of a pharmacy and a pharmacy benefit manager or third-party payer. A pharmacy benefit manager or third-party payer may not enter into any contract that establishes payment for services or medications based on an effective rate of reimbursement. A pharmacy benefit manager or third-party payer found to be in violation of this section is subject to penalties, including but not limited to fines, revocation of licensure, or other disciplinary actions.
(8) A pharmacy benefit manager may not:
(a) reimburse a network pharmacy an amount less than the contract price between the pharmacy benefit manager and the insurer, third-party payer, or the pharmacy services management organization the pharmacy benefit manager has contracted with; or
(b) require or coerce a patient to use a pharmacy that is owned by or affiliated with the pharmacy benefit manager.
(9) A pharmacy benefit manager shall apply the same utilization review, fees, copayments or cost-sharing, days allowance, and other conditions on a covered person when the covered person obtains a prescription drug from a pharmacy that is included in the pharmacy benefit manager's pharmacy network, including mail-order pharmacies and the pharmacy benefit manager's owned, affiliated, or preferred pharmacies.
(10) If a covered person is using a mail-order pharmacy, the pharmacy benefit manager shall allow for dispensing at local network pharmacies under the following circumstances to ensure patient access to prescription drugs:
(a) if the prescription is delayed more than 1 day after the expected delivery date provided by the mail-order pharmacy; or
(b) if the prescription drug arrives in an unusable condition as determined by the patient.
(11) A pharmacy benefit manager may not require the usage of mail order for a patient residing in an area where the U.S. postal service does not provide service delivery to a physical address. (Terminates June 30, 2029--sec. 8, Ch. 474, L. 2025.)