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Utah Code Title 31A. Insurance Code § 31A-46-310. Prohibited actions with respect to a federally qualified health center

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

(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.

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Cite this article: FindLaw.com - Utah Code Title 31A. Insurance Code § 31A-46-310. Prohibited actions with respect to a federally qualified health center - last updated January 01, 2025 | https://codes.findlaw.com/ut/title-31a-insurance-code/ut-code-sect-31a-46-310/

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