18 Del. Admin. Code § 1411-11.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1411-11.0 - Quarterly Reporting by PBMs

11.1 By January 15, April 15, July 15, October 15 of each year, a PBM shall provide a report of its rebating practices for the calendar quarter immediately preceding the report on a form provided by the Department (the "Rebate Report"), and shall include the following information for each insurer with which it contracts:

11.1.1 The name and Delaware registration number of the PBM;

11.1.2 The name and contact information of the person responsible for completing and filing the report with the Department;

11.1.3 The itemized amount of pharmacy benefits manager revenue sources, including professional fees, administrative fees, processing fees, audits, direct and indirect renumeration fees, or any other fees;

11.1.4 The aggregate dollar amount of rebates distributed to the appropriate insurer;

11.1.5 The aggregate dollar amount of rebates passed on to insureds of each insurer at the point of sale that reduced the insureds' applicable deductible, copayment, coinsurance, or other cost-sharing amount;

11.1.6 The individual and aggregate amount the insurer paid to the pharmacy benefits manager for pharmacy goods or services, itemized by all of the following:

11.1.6.1 Pharmacy;

11.1.6.2 Product; and

11.1.6.3 Goods and services; and

11.1.7 The individual and aggregate amount a pharmacy benefits manager paid for pharmacy goods or services, itemized by each of the following:

11.1.7.1 Pharmacy;

11.1.7.2 Product; and

11.1.7.3 Goods and services.

11.2 Failure to timely file a report as required under Section 11.0 of this regulation may result in the nonrenewal, suspension or revocation of the PBM's registration as set forth in 18 Del.C. Ch. 33A.

18 Del. Admin. Code § 1411-11.0

26 DE Reg. 594 (1/1/2023) (Final)