33-22-170. (Temporary) Definitions.
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/mt/title-33/chapter-22/part-1/33-22-170·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
33-22-170 . (Temporary) Definitions. As used in 33-22-170 through 33-22-177 and 33-22-180 , the following definitions apply:
(1)"Contract pharmacy" means a pharmacy operating under contract with a federally certified health entity to provide dispensing services to the federally certified health entity.
(2)"Effective rate contracting" means an agreement or arrangement between a pharmacy or a contracting agent acting on behalf of a pharmacy and a pharmacy benefit manager or third-party payer that establishes a reimbursement rate for pharmaceuticals based on the effective rate of payment rather than on a predetermined fixed price or a fixed discount percentage. An effective rate of payment involves any calculation for which pharmacy reimbursement is based on an aggregation of more than one claim, rather than on a per-claim basis.
(3)"Federally certified health entity" means a 340B covered entity as described in 42 U.S.C. 256b(a)(4).
(4)"Independent pharmacy" means a pharmacy as defined in 37-7-101 that:
(a)is licensed with the board of pharmacy as a pharmacy;
(b)is located in the state; and
(c)is not owned or operated by or a subsidiary or affiliate of:
(i)a for-profit entity with more than 10 pharmacy locations nationwide;
(ii)a pharmacy benefit manager; or
(iii)a publicly traded entity.
(5)"Maximum allowable cost list" means the list of drugs used by a pharmacy benefit manager that sets the maximum cost on which reimbursement to a network pharmacy or pharmacist is based.
(6)"Pharmacist" means a person licensed by the state to engage in the practice of pharmacy pursuant to Title 37, chapter 7.
(7)"Pharmacy" means an established location, either physical or electronic, that is licensed by the board of pharmacy pursuant to Title 37, chapter 7, and that has entered into a network contract with a pharmacy benefit manager, health insurance issuer, or plan sponsor.
(8)"Pharmacy benefit manager" means a person who contracts with pharmacies on behalf of a health insurance issuer, third-party administrator, or plan sponsor to process claims for prescription drugs, provide retail network management for pharmacies or pharmacists, pay pharmacies or pharmacists for prescription drugs, or provide other prescription drug or device services.
(9)"Pharmacy performance measurement entity" means:
(a)the electronic quality improvement platform for plans and pharmacies; or
(b)an entity approved by the board of pharmacy provided for in 2-15-1733 as a nationally recognized and unbiased entity that assists pharmacies in improving performance measures.
(10)"Pharmacy services administrative organization" means an entity that acts as a contracting agent or provides contracting and other administrative services to pharmacies to assist them in their interactions with third-party payers and pharmacy benefit managers.
(11)"Prescription drug" means any drug that is required by federal law or regulation to be dispensed only by a prescription subject to section 353(b) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 301 et seq.
(12)"Prescription drug order" has the meaning provided in 37-7-101 .
(13)"Reference pricing" means a calculation for the price of a pharmaceutical that uses the most current nationally recognized reference price or amount to set the reimbursement for prescription drugs and other products, supplies, and services covered by a network contract between a plan sponsor, health insurance issuer, or pharmacy benefit manager and a pharmacy or pharmacist. (Terminates June 30, 2029--sec. 8, Ch. 474, L. 2025.)