N.Y. Comp. Codes R. & Regs. tit. 11 § 456.3

Current through Register Vol. 46, No. 53, December 31, 2024

Section 456.3 - Credentialing, certification, and accreditation requirements

(a) For purposes of credentialing a pharmacy as a condition for enrolling or participating in a pharmacy benefit manager's network, a pharmacy benefit manager shall not require a pharmacy to recredential more frequently than once every three years.

(b) A pharmacy benefit manager shall notify a pharmacy, in writing, of any:

(1) credentialing requirements for participation or enrollment in a pharmacy network upon request by a pharmacy within 14 days from the date of the request; and

(2) any re-credentialing requirements for continued participation or enrollment in a pharmacy network at least 30 days prior to the date the pharmacy must submit the requested information and documents for such re-credentialing to the pharmacy benefit manager. The 30-day period shall begin from the date of postmark if the notification is sent via postal mail or from the date of transmittal if the notification is sent electronically or by fax.

(c) A pharmacy benefit manager shall allow a pharmacy to submit all documents and information required as part of any credentialing and recredentialing requirements electronically and, to the extent consistent with applicable law, allow for the use of electronic signatures.

(d) A pharmacy benefit manager shall provide to a pharmacy, within 30 days of receipt of a written request from the pharmacy, a written notice of any certification or accreditation requirements used by the pharmacy benefit manager as a determinant of network participation. A pharmacy benefit manager shall not change its accreditation requirements more than once every 12 months.

(e) If a pharmacy benefit manager determines not to renew a pharmacy contract for any reason related to credentialing, certification, or accreditation requirements, the pharmacy benefit manager shall notify the pharmacy of the non-renewal determination in writing, together with a specific explanation of the reason for such non-renewal. Such explanation shall have a rational basis.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 456.3

Adopted New York State Register November 27, 2024/Volume XLVI, Issue 48, eff. 11/27/2024