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Pennsylvania Statutes Title 40 P.S. Insurance § 4528. Network adequacy

Current as of January 01, 2025 | Updated by Findlaw Staff

<Section 14(1) of Act 2024, July 17, P.L. 852, No. 77, provides that the addition of Chapter 6 by that Act shall apply to contracts issued, renewed or amended after Oct. 15, 2024. See, also, additional applicability provisions in § 14(2) of such Act.>

(a) General rule.--A PBM shall establish a reasonably adequate and accessible retail pharmacy network for the provision of prescription drugs under a health benefit plan that shall provide for convenient patient access to pharmacies within a reasonable distance from a patient's residence in accordance with the following requirements:

(1) The network may not be limited to affiliated pharmacies only.

(2) The network shall meet or exceed the requirements of 42 CFR 423.120(a) (relating to access to covered part D drugs) or a successor regulation. If a PBM fails to comply with the requirements, it shall not be considered a violation if the PBM contracts with all retail pharmacies within the network distance standards of the health benefit plan participants.

(b) Report requirement.--Beginning April 1, 2026, and annually thereafter, a PBM shall file with the department a network adequacy report, on a form prescribed by the department, describing the PBM network and the PBM network's accessibility in this Commonwealth. The reports shall be posted on the department's publicly accessible Internet website.

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Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 4528. Network adequacy - last updated January 01, 2025 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-4528/

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