211 CMR, § 44.04

Current through Register 1536, December 6, 2024
Section 44.04 - Bid Disclosure and Confidentiality Requirements
(1)Bid Disclosure: A Carrier shall open all Restricted Pharmacy Network contract bids in a public manner in accordance with the requirements of M.G.L. c. 176D, § 3B subject to the restrictions set forth in 211 CMR 44.04(2)(a) and (b).
(2)
(a)Proprietary Data and Information: Except as provided for in 211 CMR 44.04(2)(b), a Carrier shall withhold proprietary data and information contained in the Restricted Pharmacy Network contact bids as confidential from public view. Proprietary data and information shall include :
1. a Carrier's or an Eligible Bidder's marketing strategy;
2. a description of a Carrier's or an Eligible Bidder's information system, computer programs or other on-line service;
3. a Carrier's projected utilization information;
4. rebates, refunds, discount amounts or formulas, volume discounts, any class of trade discounts or any estimated unit and dollar volume discounts provided to an Eligible Bidder by drug manufacturers or pharmaceutical companies;
5. proposed discounts from the average wholesale price, dispensing fees, capitation or other risk-sharing methodology, or ingredient costs;
6. a Carrier's closed formulary;
7. descriptions of unique, plan-specific programs or techniques including cost containment efforts, drug utilization review, formulary compliance assistance, disease management, outcomes management, patient compliance, generic utilization, generic and therapeutic substitution programs; and
8. lists of pharmacies included in the network of an Eligible Bidder which is not chosen in the bidding process by a Carrier to participate in the Carrier's Restricted Pharmacy Network.
(b)Limited Disclosure: Notwithstanding the provisions in 211 CMR 44.04(2)(a), any final price per prescription information contained in the bid shall be disclosed to only an Eligible Bidder or a Willing Pharmacy Provider; provided, however, if the bid does not contain any final price per prescription information, the price methodology described in the bid, including, but not limited to, discounts from the average wholesale price, dispensing fees, capitation or other risk-sharing methodology or ingredient costs, shall instead be disclosed to only an Eligible Bidder or a Willing Pharmacy Provider. The Eligible Bidder or a Willing Pharmacy Provider shall not release the information to any other entity or person.

211 CMR, § 44.04