(1) "Health benefit plan" means: (a) a health benefit plan as defined in Section 31A-1-301; or (b) a health, dental, medical, Medicare supplement, or conversion program offered under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act.
(a) a health benefit plan as defined in Section 31A-1-301; or
(b) a health, dental, medical, Medicare supplement, or conversion program offered under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act.
(2) "Pharmacist" is as defined in Section 58-17b-102.
(3) "Pharmacy" is as defined in Section 58-17b-102.
(4) "Pharmacy benefits management service" means any of the following services provided to a health benefit plan, or to a participant of the health benefit plan: (a) negotiating the amount to be paid by a health benefit plan for a prescription drug; or (b) administering or managing prescription drug benefits provided by the health benefit plan for the benefit of a participant of the health benefit plan, including: (i) mail service pharmacy; (ii) specialty pharmacy; (iii) claims processing; (iv) payment of a claim; (v) retail network management; (vi) clinical formulary development; (vii) clinical formulary management services; (viii) rebate contracting; (ix) rebate administration; (x) a participant compliance program; (xi) a therapeutic intervention program; (xii) a disease management program; or (xiii) a service that is similar to, or related to, a service described in Subsection (4)(a) or (4)(b)(i) through (xii).
(a) negotiating the amount to be paid by a health benefit plan for a prescription drug; or
(b) administering or managing prescription drug benefits provided by the health benefit plan for the benefit of a participant of the health benefit plan, including: (i) mail service pharmacy; (ii) specialty pharmacy; (iii) claims processing; (iv) payment of a claim; (v) retail network management; (vi) clinical formulary development; (vii) clinical formulary management services; (viii) rebate contracting; (ix) rebate administration; (x) a participant compliance program; (xi) a therapeutic intervention program; (xii) a disease management program; or (xiii) a service that is similar to, or related to, a service described in Subsection (4)(a) or (4)(b)(i) through (xii).
(i) mail service pharmacy;
(ii) specialty pharmacy;
(iii) claims processing;
(iv) payment of a claim;
(v) retail network management;
(vi) clinical formulary development;
(vii) clinical formulary management services;
(viii) rebate contracting;
(ix) rebate administration;
(x) a participant compliance program;
(xi) a therapeutic intervention program;
(xii) a disease management program; or
(xiii) a service that is similar to, or related to, a service described in Subsection (4)(a) or (4)(b)(i) through (xii).
(5) "Pharmacy benefits manager" means a person that provides a pharmacy benefits management service to a health benefit plan.
(6) "Pharmacy service" means a product, good, or service provided by a pharmacy or pharmacist to an individual.
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