205.5518 Required and prohibited actions by pharmacy benefit manager -- Penalty
269 words·~1 min read·
/ky/205-5518A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
for violation.
(1)Notwithstanding any provisions of law to the contrary, beginning on March 27,
2020, and continuing until December 31, 2020, a pharmacy benefit manager
contracted with a managed care organization to administer Medicaid benefits shall
not:
(a)Adjust, modify, change, or amend reimbursement methodologies, dispensing
fees, and any other fees paid by the pharmacy benefit manager to pharmacies
licensed in the Commonwealth;
(b)Create, modify, implement, or indirectly establish any fee on a pharmacy,
pharmacist, or a Medicaid recipient in the Commonwealth; and
(c)Make any adjustments, modifications, or changes to a pharmacy network for
the managed care organization with whom the pharmacy benefit manager has
contracted to administer Medicaid benefits.
(2)Notwithstanding any provisions of law to the contrary, beginning on March 27,
2020, and continuing until December 31, 2020, a pharmacy benefit manager
contracted with a managed care organization to administer Medicaid benefits shall:
(a)Administer, adjudicate, and, when appropriate, reimburse any pharmacy
benefit claim submitted to the managed care organization prior to the
termination of the contract between the pharmacy benefit manager and the
managed care organization in accordance with the contract between the
pharmacy benefit manager and the managed care organization; and
(b)Not be released from its obligation to make any payments owed to a pharmacy
licensed in the Commonwealth for pharmacy services rendered prior to the
termination of the contract between the pharmacy benefit manager and the
managed care organization.
(3)The department shall impose a fine of twenty-five thousand dollars ($25,000) per
day per separate violation on a pharmacy benefit manager who violates subsection
(1)or
(2)of this section.