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Current as of January 01, 2023 | Updated by Findlaw Staff
The following definitions apply in this Article:
(1) Reserved.
(2) Independent pharmacy.--As defined in G.S. 58-51-37.
(3) Insured.--An individual covered by a health benefit plan.
(4) Pharmacy.--As defined in G.S. 58-51-37.
(5) Pharmacy benefits manager or PBM.--As defined in G.S. 58-56A-1.
(6) Pharmacy services administrative organization or PSAO.--An entity operating within this State that contracts with one or more independent pharmacies to conduct business with third-party payers on behalf of the independent pharmacy or pharmacies to provide administrative services to the independent pharmacy or pharmacies and to negotiate and enter into contracts with third-party payers or PBMs on behalf of the independent pharmacy or pharmacies. Administrative services provided on behalf of one or more independent pharmacies may include one or more of the following:
a. Assistance with claims.
b. Assistance with audits.
c. Centralized payment.
d. Certification in specialized care programs.
e. Compliance support.
f. Setting flat fees for generic drugs.
g. Assistance with store layout.
h. Inventory management.
i. Marketing support.
j. Management and analysis of payment and drug dispensing data.
k. Provision of services for retail cash cards.
(7) PSAO-pharmacy contract.--A contractual agreement between a PSAO and an independent pharmacy under which a PSAO agrees to negotiate with PBMs or third-party payers or both on behalf of an independent pharmacy. A PSAO-pharmacy contract may contain an agreement that the PSAO will provide other services to the independent pharmacy in addition to negotiation with PBMs or third-party payers.
(8) Reserved.
(9) Wholesale distributor.--As defined in G.S. 106-145.2.
Cite this article: FindLaw.com - North Carolina General Statutes Chapter 58. Insurance § 58-56B-1. Definitions - last updated January 01, 2023 | https://codes.findlaw.com/nc/chapter-58-insurance/nc-gen-st-sect-58-56b-1/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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