31A-46-310. Prohibited actions with respect to a federally qualified health center.

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

Effective 5/5/2021

(1)As used in this section, "federally qualified health center":

(a)means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and

(b)includes the pharmacy or pharmacies that are operated by or contract with a federally qualified health center described in Subsection (1)(a) to dispense drugs purchased through the federally qualified health center.

(2)This section applies to a contract entered into or renewed on or after January 1, 2022, between an insurer and a pharmacy described in Subsection (1)(b) .

(3)An insurer may not vary the amount that the insurer reimburses to a federally qualified health center for a drug on the basis of whether:

(a)the drug is a 340B drug; or

(b)the pharmacy is a 340B entity.

(4)Subsection

(3)does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.

(5)An insurer or an insurer's pharmacy service entity may not:

(a)on the basis that a federally qualified health center participates, directly or through a contractual arrangement, in the 340B drug discount program:

(i)assess a fee, charge-back, or other adjustment on a federally qualified health center;

(ii)restrict access to the insurer's pharmacy network;

(iii)require the federally qualified health center to enter into a contract with a specific pharmacy to participate in the insurer's pharmacy network;

(iv)create a restriction or an additional charge on a patient who chooses to receive drugs from a federally qualified health center; or

(v)create any additional requirements or restrictions on the federally qualified health center; or

(b)require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program.

Enacted by Chapter 317 , 2021 General Session