§ 5-19.3-3. Prohibition of certain discriminatory actions related to reimbursement of 340B covered
entities and 340B contract pharmacies.
(a) With respect to reimbursement to a 340B covered entity for 340B drugs, a health insurer,
pharmacy benefit manager, manufacturer, other third-party payor, or its agent shall
not do any of the following:
(1) Establish a lower reimbursement amount to a 340B covered entity or 340B contract pharmacy
for a 340B drug than it would be paid for a non-340B drug, based solely on the drug's
340B status;
(2) Impose fees, chargebacks, adjustments, or conditions on reimbursement to a 340B covered
entity, that differs from such terms or conditions applied to a non-340B entity, based
on 340B status and participation in the federal 340B drug discount program set forth
in 42 U.S.C. § 256b;
(3) Deny or limit participation in standard or preferred pharmacy networks based on 340B
status;
(4) Impose requirements relating to the frequency or scope of audits of inventory management
systems inconsistent with the federal 340B drug pricing program;
(5) Require submission of claims-level data or documentation that identifies 340B drugs
as a condition of reimbursement or pricing, unless it is required by the Centers for
Medicare and Medicaid Services;
(6) Require a 340B covered entity to reverse, resubmit, or clarify a claim after the initial
adjudication unless these actions are in the normal course of pharmacy business and
not related to 340B drug pricing;
(7) Interfere with, or limit, a 340B covered entity's choice to use a contract pharmacy
for drug distribution or dispensing;
(8) Include any other provision in a contract between a health insurer, pharmacy benefit
manager, manufacturer, or other third-party payor and a 340B covered entity that differ
from the terms and conditions applied to entities that are not 340B covered entities,
that discriminates against the 340B covered entity or prevents or interferes with
an individual's choice to receive a prescription drug from a 340B covered entity,
including the administration of such drugs in person or via direct delivery, mail,
or other form of shipment, or create a restriction or additional charge on a patient
who chooses to receive drugs from a 340B covered entity;
(9) Place a restriction or additional charge on a patient who chooses to receive 340B
drugs from a 340B covered entity if such restriction or additional charge differs
from the terms and conditions applied where patients choose to receive drugs that
are not 340B drugs from an entity that is not a 340B covered entity or from a pharmacy
that is not a 340B contract pharmacy;
(10) Exclude any 340B covered entity from a health insurer, pharmacy benefit manager, or
other third-party payor network or refuse to contract with a 340B covered entity for
reasons other than those that apply equally to a non-340B entity;
(11) Impose any other restrictions, requirements, practices, or policies that are not imposed
on a non-340B entity.
(b) Nothing in this section is intended to limit a health insurer or pharmacy benefit
manager's ability to use preferred pharmacies or develop preferred networks so long
as participation is not based on an entity's status as a 340B covered entity and participation
in the network is subject to the same terms and conditions as a non-340B covered entity.