§ 26-52-105 — Transparency; prohibitions

Wyoming § 26-52-105

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 52: PHARMACY BENEFIT MANAGERS AND PAYMENT OF PHARMACY

Text

(a) A pharmacy benefit manager or an agent of a pharmacy
benefit manager shall not:
(i) Cause or knowingly permit the use of an
advertisement, promotion, solicitation, representation, proposal
or offer that is untrue, deceptive or misleading;
(ii) Charge a pharmacist or pharmacy provider a fee
for any of the following:
(A) The submission of a claim;
(B) Enrollment or participation in a retail
pharmacy network;
(C) The development or management of claims
processing services or claims payment services related to
participation in a retail pharmacy network;
(D) An application to apply for network access
with the pharmacy benefit manager;
(E) Credentialing or re-credentialing.
(iii) Retroactively deny or reduce reimbursement for
a covered pharmacy service or claim after adjudication of the
claim, unless:
(A) The original claim was fraudulent; or
(B) The denial or reduction is necessary to
correct errors found in an audit, provided that the audit was
conducted in compliance with W.S. 26-52-103.
(vii) Prohibit a pharmacy, pharmacy services
administrative organization, contracting agent or agent of a
pharmacy from sharing, upon request, copies of pharmacy benefit
manager contracts with the department of insurance;
(viii) Prohibit, restrict or limit disclosure of
information to the insurance commissioner, law enforcement or
other state or federal government officials who are
investigating or examining a complaint or conducting a review of
the pharmacy benefit manager's compliance with the requirements
of this chapter.
(c) Insurers, pharmacies and pharmacy benefit managers
shall adhere to all state laws and rules when mailing or
shipping prescription drugs into the state.