§ 58-56B-35. (Effective October 1, 2026) Appeals.

244 words·~1 min read·/nc/chapter-58/58-56b-35

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

(a)Disputes. - If there is a dispute between an independent pharmacy and a PBM or third-party payer, then a PSAO which has entered into a PSAO-pharmacy contract with that independent pharmacy shall ensure and facilitate timely communication between the pharmacy and the PBM or third-party payer.

(b)PSAO Contracted with an Independent Pharmacy. - If a third-party payer or a PBM provides any notice or other information to a PSAO that is related to an independent pharmacy with which the PSAO has entered into a PSAO-pharmacy contract, then that shall be considered provision of that notice or other information to the pharmacy with which the PSAO is contracted. A third-party payer or PBM shall not be required to provide notice or other information to both the PSAO and the independent pharmacy with which the PSAO has entered into a PSAO-pharmacy contract.

(c)Timeliness. - A PSAO shall forward all notices of appeals from an independent pharmacy with which the PSAO has entered into a PSAO-pharmacy contract to the relevant PBM or third-party payer in a timely manner.

(d)Denials. - If an appeal received by a PSAO from an independent pharmacy does not meet the minimum requirements contained within a PSAO-pharmacy contract, then the PSAO shall notify the pharmacy and provide the denial reason or reasons. The PSAO shall allow the pharmacy to resubmit the appeal for review by a PBM, if applicable. (2025-69, s. 2.1.)