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Utah Code Title 31A. Insurance Code § 31A-46-309. Reimbursement--Prohibitions

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

(1) This section applies to a contract entered into or renewed on or after January 1, 2021, between a pharmacy benefit manager and a pharmacy.

(2) A pharmacy benefit manager may not vary the amount it reimburses a pharmacy for a drug on the basis of whether:

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

(b) the pharmacy is a 340B entity.

(3) Subsection (2) does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.

(4) A pharmacy benefit manager may not:

(a) on the basis that a 340B entity participates, directly or indirectly, in the 340B drug discount program:

(i) assess a fee, charge-back, or other adjustment on the 340B entity;

(ii) restrict access to the pharmacy benefit manager’s pharmacy network;

(iii) require the 340B entity to enter into a contract with a specific pharmacy to participate in the pharmacy benefit manager’s pharmacy network;

(iv) create a restriction or an additional charge on a patient who chooses to receive drugs from a 340B entity; or

(v) create any additional requirements or restrictions on the 340B entity; 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.

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Cite this article: FindLaw.com - Utah Code Title 31A. Insurance Code § 31A-46-309. Reimbursement--Prohibitions - last updated January 01, 2025 | https://codes.findlaw.com/ut/title-31a-insurance-code/ut-code-sect-31a-46-309/

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