Sec. 21.27.907. Duty of care.

468 words·~2 min read·/ak/title-21/chapter-27/21-27-907

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)A pharmacy benefits manager owes a duty of care to a plan sponsor, benefits administrator, and covered person. A pharmacy benefits manager shall adhere to the practices set out in this section.

(b)A pharmacy benefits manager shall

(1)perform the manager's duties with care, skill, prudence, diligence, fairness, transparency, and professionalism and in the best interest of the plan sponsor, benefits administrator, and covered person as required by this section; and

(2)notify the plan sponsor in writing of any activity, policy, or practice of the pharmacy benefits manager that directly or indirectly presents any conflict of interest with the duties imposed by this chapter.

(c)The duty of care owed to a covered person under this section takes precedence over the duty of care owed to any other person.

(d)A pharmacy benefits manager that receives from a drug manufacturer or labeler a payment or benefit of any kind in connection with the use of a prescription drug by a covered person, including a payment or benefit based on volume of sales or market share, shall pass that payment or benefit on in full to the plan sponsor.

(e)Upon request by a plan sponsor, a pharmacy benefits manager shall

(1)provide information showing the quantity of drugs purchased by the covered person and the net cost to the covered person for the drugs; the information must include all rebates, discounts, and other similar payments; if requested by the plan sponsor, the pharmacy benefits manager shall provide the quantity and net cost information on a drug-by-drug basis by national drug code registration number rather than on an aggregated basis; and

(2)disclose to the plan sponsor all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefits manager and a prescription drug manufacturer or labeler, including formulary management and drug-substitution programs, educational support, claims processing, and data sales fees.

(f)A pharmacy benefits manager providing information to a plan sponsor under

(e)of this section may designate that information as confidential. Information designated as confidential may not be disclosed by the plan sponsor to another person without the consent of the pharmacy benefits manager, unless ordered by a court.

(g)If a pharmacy dispenses a substitute prescription drug for a prescribed drug to a covered person and the substitute prescription drug costs more than the prescribed drug, the pharmacy benefits manager shall disclose to the plan sponsor the cost of both drugs and any benefit or payment directly or indirectly accruing to the pharmacy benefits manager as a result of the substitution. The pharmacy benefits manager shall transfer in full to the plan sponsor a benefit or payment received in any form by the pharmacy benefits manager as a result of a prescription drug substitution.