La. Admin. Code tit. 37 § XIII-18509

Current through Register Vol. 50, No. 6, June 20, 2024

Section XIII-18509 - Roles and Responsibilities of Pharmacy Services Administrative Organizations

A. The roles and responsibilities solely within the purview of pharmacy services administrative organizations are as follows:

1. negotiating contracts, drug reimbursement rates, payments, and audit terms on behalf of pharmacy clients with pharmacy benefit managers;

2. billing and collecting payments from payers on behalf of pharmacies;

3. using contractual agreements to develop networks of member pharmacies. These agreements generally authorize pharmacy services administrative organizations to interact with third-party payers and pharmacy benefit managers;

4. negotiating access for pharmacies to networks and patients;

5. facilitating the purchase of prescription drugs and other medical products from drug manufacturers and providing for delivery to pharmacies for dispensing; and

6. assisting pharmacy clients with business strategy, pricing appeals, claims reconciliation, and certification and credentialing requirements.

La. Admin. Code tit. 37, § XIII-18509

Promulgated by the Department of Insurance, Office of the Commissioner, LR 482300 (9/1/2022).

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:11, R.S. 22:1641(8), R.S. 22:1655, R.S. 22:1660.1(B)(1), R.S. 22:1660.8, R.S. 22:1660.9(C) and the Administrative Procedure Act, R.S. 49:950 et seq.