Current through the 2024 Fourth Special Session
Section 31A-46-309 - Reimbursement - Prohibitions(1) This section applies to a contract entered into or renewed on or after January 1, 2021, between a pharmacy benefit manager and a pharmacy.(2) A pharmacy benefit manager may not vary the amount it reimburses a pharmacy for a drug on the basis of whether: (a) the drug is a 340B drug; or(b) the pharmacy is a 340B entity.(3) Subsection (2) does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.(4) A pharmacy benefit manager may not:(a) on the basis that a 340B entity participates, directly or indirectly, in the 340B drug discount program: (i) assess a fee, charge-back, or other adjustment on the 340B entity;(ii) restrict access to the pharmacy benefit manager's pharmacy network;(iii) require the 340B entity to enter into a contract with a specific pharmacy to participate in the pharmacy benefit manager's pharmacy network;(iv) create a restriction or an additional charge on a patient who chooses to receive drugs from a 340B entity; or(v) create any additional requirements or restrictions on the 340B entity; or(b) require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program.Added by Chapter 275, 2020 General Session ,§ 5, eff. 5/12/2020.Technically renumbered to avoid duplication of section number also enacted in HB272, Chapter 198.