N.M. Admin. Code § 13.10.30.14

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.30.14 - SEARCHABLE ONLINE DATABASE OF DRUG PRICES

A.Update timeframe. A PBM shall update its MAC list at least once every seven days.

B.Searchable online database required. A PBM shall establish a searchable online database that will allow a network pharmacy to search MAC list prices for a particular drug for as long as the pharmacy has the right to file a MAC appeal or grievance concerning a specific fill. The PBM's provider manual shall include instructions for accessing the price list on the PBM's website. The provider manual shall be transmitted to a newly joined pharmacy within 10 business days from the date of execution of a contract with the PBM. A PBM shall provide an updated version of its provider manual within 30 days of any revisions to all network pharmacies.

C.Search requirements. The database shall be searchable by NDC or drug name, and specific plan identifier.

D.Drug information. The information provided for the drug shall contain:

(1) NDC;

(2) NDC description;

(3) MAC list price; and

(4) effective date.

E.Instructions required. The provider manual shall contain instructions for searching the MAC list and contain instructions for requesting the name of the sources used to determine MAC pricing for the MAC list. A network pharmacy may request the name of the sources through a PBM's website, e-mail, facsimile or letter, if they are not already included in the provider manual. The PBM shall respond with the names of the sources within 10 business days from the date of the request.

F.Website requirements. The PBM's website shall contain a prominent link to request the names of the sources used to establish the MAC price.

G.Accessibility. Upon request a PBM shall provide the superintendent information contained in the database to determine compliance with these rules or to resolve a grievance.

N.M. Admin. Code § 13.10.30.14

Adopted by New Mexico Register, Volume XXXII, Issue 02, January 26, 2021, eff. 3/1/2021, Adopted by New Mexico Register, Volume XXXIII, Issue 04, February 22, 2022, eff. 3/1/2022