<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-1630" title_number="15" title_name="Health Insurance" subtitle_number="16" subtitle_name="Pharmacy Benefits Managers">
  <level label="a">
    <text>This section applies only to a pharmacy benefits manager that provides pharmacy benefits management services on behalf of a carrier.</text>
  </level>
  <level label="b">
    <text>A pharmacy benefits manager shall establish a reasonable internal review process for a pharmacy to request the review of a failure to pay the contractual reimbursement amount of a submitted claim.</text>
  </level>
  <level label="c">
    <text>A pharmacy may request a pharmacy benefits manager to review a failure to pay the contractual reimbursement amount of a claim within 180 calendar days after the date the submitted claim was paid by the pharmacy benefits manager.</text>
  </level>
  <level label="d">
    <text>The pharmacy benefits manager shall give written notice of its review decision within 90 calendar days after receipt of a request for review from a pharmacy under this section.</text>
  </level>
  <level label="e">
    <text>If the pharmacy benefits manager determines through the internal review process established under subsection (b) of this section that the pharmacy benefits manager underpaid a pharmacy, the pharmacy benefits manager shall pay any money due to the pharmacy within 30 working days after completion of the internal review process.</text>
  </level>
  <level label="f">
    <text>This section may not be construed to limit the ability of a pharmacy and a pharmacy benefits manager to contractually agree that a pharmacy may have more than 180 calendar days to request an internal review of a failure of the pharmacy benefits manager to pay the contractual amount of a submitted claim.</text>
  </level>
</section>
