33-22-175. (Effective January 1, 2020) Allowable and prohibited fees on pharmacies. (1) A pharmacy benefit manager or third-party payer may not directly or indirectly charge or hold a pharmacy responsible for a fee related to a claim:
(a) if the fee is not apparent at the time the claim is processed;
(b) if the fee is not reported on the remittance advice of an adjudicated claim; or
(c) after the initial claim is adjudicated.
(2) A pharmacy benefit manager or third-party payer may collect a performance-based fee from a pharmacy only if the pharmacy fails to meet the criteria established by a pharmacy performance measurement entity. The fee may be applied only to the professional dispensing fee outlined in the contract with the pharmacy and may not be imposed on the cost of goods sold by a pharmacy.
(3) Only criteria established by a pharmacy performance measurement entity may be used to measure a pharmacy's performance for the purposes of this section.
History: En. Sec. 1, Ch. 88, L. 2019.
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