49-20-503. Request for proposals for pharmacy benefits manager for Public Employees' Benefit and Insurance Program.
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49-20-503. Request for proposals for pharmacy benefits manager for Public Employees' Benefit and Insurance Program.
(1)When the board issues a request for proposals for a pharmacy benefits manager to provide pharmacy benefits management services for the program, the request for proposals shall:
(a)require each responder to comply with the pharmacy audit provisions of Section 58-17b-622 ; and
(b)provide each responder with the option to include, among the billing options proposed, a billing option that complies with the requirements described in this section.
(2)The billing option described in Subsection
(1)shall require the pharmacy benefits manager to, on at least a monthly basis, submit to the board an invoice for all pharmacy services paid by the pharmacy benefits manager on behalf of the program since the last request for payment or reimbursement.
(3)The invoice described in Subsection
(2)shall state, as a separate item from any other amount:
(a)the total amount due to the pharmacy benefits manager for all pharmacy services billed in the invoice; and
(b)the total amount paid by the pharmacy benefits manager for the same pharmacy services for which payment is sought in that invoice.
Amended by Chapter 265 , 2012 General Session