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<section article="gin" article_name="Insurance" number="15-1611.2" title_number="15" title_name="Health Insurance" subtitle_number="16" subtitle_name="Pharmacy Benefits Managers">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Covered entity” has the meaning stated in § 602 of the federal Veterans Health Care Act of 1992.</text>
    </level>
    <level label="3">
      <text>“Pharmacies or pharmacists that participate in the 340B Program” means:</text>
      <level label="i">
        <text>a pharmacy owned or operated by a covered entity that is eligible to or is actively participating in the 340B Program; or</text>
      </level>
      <level label="ii">
        <text>a pharmacy or pharmacist under contract with a covered entity to dispense drugs purchased under the 340B Program to patients of the covered entity.</text>
      </level>
    </level>
    <level label="4">
      <text>“340B Program” means the drug pricing program established under § 602 of the federal Veterans Health Care Act of 1992.</text>
    </level>
  </level>
  <level label="b">
    <text>A pharmacy benefits manager shall:</text>
    <level label="1">
      <text>make formulary and coverage decisions for a pharmacy or pharmacist that participates in the 340B Program based on the normal course of business of the pharmacy benefits manager; and</text>
    </level>
    <level label="2">
      <text>allow a beneficiary to use any in–network pharmacy or pharmacist that the beneficiary choses, without regard to whether the pharmacy or pharmacist participates in the 340B Program.</text>
    </level>
  </level>
  <level label="c">
    <text>A pharmacy benefits manager may not:</text>
    <level label="1">
      <text>transfer the 340B Program savings from a pharmacy or pharmacist that participates in the 340B Program to a pharmacy benefits manager;</text>
    </level>
    <level label="2">
      <text>offer lower reimbursement for a prescription drug purchased under the 340B Program than the reimbursement it offers for the same prescription drug if it is not purchased under the 340B Program;</text>
    </level>
    <level label="3">
      <text>refuse to cover the prescription drugs purchased under the 340B Program;</text>
    </level>
    <level label="4">
      <text>refuse to allow pharmacies or pharmacists that participate in the 340B Program to participate in the pharmacy benefits manager’s network on the sole basis that the pharmacy or pharmacist participates in the 340B Program;</text>
    </level>
    <level label="5">
      <text>impose different reimbursement or network participation contract terms on pharmacies or pharmacists that participate in a pharmacy benefits manager’s network based on whether a pharmacy or pharmacist participates in the 340B Program;</text>
    </level>
    <level label="6">
      <text>impose different fees, chargebacks, or other adjustments on pharmacies or pharmacists based on whether a pharmacy or pharmacist participates in the 340B Program;</text>
    </level>
    <level label="7">
      <text>modify a beneficiary’s copayment on the basis of whether a pharmacy or pharmacist participates in the 340B Program;</text>
    </level>
    <level label="8">
      <text>establish or set network adequacy requirements based on whether a pharmacy or pharmacist participates in the 340B Program; or</text>
    </level>
    <level label="9">
      <text>prohibit a covered entity authorized to participate in the 340B Program or a pharmacy or pharmacist under contract with a covered entity authorized to participate in the 340B Program from participating in the pharmacy benefits manager’s network on the basis of the covered entity’s participation in the 340B Program.</text>
    </level>
  </level>
  <level label="d">
    <text>A pharmacy benefits manager may not base formulary or prescription drug coverage decisions on:</text>
    <level label="1">
      <text>the price of the prescription drug under the 340B Program; or</text>
    </level>
    <level label="2">
      <text>whether the dispensing pharmacy or pharmacist participates in the 340B Program.</text>
    </level>
  </level>
</section>
