Kan. Admin. Regs. § 40-1-54

Current through Register Vol. 43, No. 49, December 5, 2024

Section 40-1-54 - Pharmacy benefits manager; network adequacy report

Each applicant for license to act as a pharmacy benefits manager shall submit a network adequacy report to the commissioner with the application that contains the following information:

(a) The name and address of the pharmacy benefits manager;

(b) the name, telephone number, and electronic-mail address of the contact person responsible for the license of the pharmacy benefits manager;

(c) the name of each network administered in Kansas by the applicant;

(d) the number of counties and a list of the counties in each service area;

(e) the number of afliated pharmacies in Kansas that are in the applicant's networks;

(f) the number of independent pharmacies in Kansas that are in the applicant's networks;

(g) the number of complaints submited by pharmacies concerning the applicant's network that the applicant has received in the previous 12 months. "Complaints" shall include complaints submited in writing, by phone, by electronic mail, or by other electronic means;

(h) the number of complaints submited by patients concerning the applicant's network that the applicant has received in the previous 12 months. "Complaints" shall include complaints submited in writing, by phone, by electronic-mail, or by other electronic means; and

(i) a writen narrative that meets the following requirements:

(1) Describes the process for determining the reasonableness of patient access to a pharmacy based on distance from the patient's residence, including whether any afliates are included in the calculation of distance between patient residence and pharmacy, and a description of how mail-order and physical store locations are factored into the reasonableness determination;

(2) specifes whether the applicant's contracts require patients to use pharmacies that are directly or indirectly owned by the applicant and any requirements for new prescriptions, reflls, or specialty drugs, regardless of days supply;

(3) specifes whether the applicant imposes limits, including quantity limits or refll limits, on an independent pharmacy's access to medications that difer from the limits imposed on the applicant's afliates;

(4) specifes how the applicant's certifcation or accreditation requirements are used as a determinant of network participation;

(5) specifes how often certifcation or accreditation requirements are changed;

(6) specifes whether there are diferent standards for independent pharmacies and afliates of the applicant and how these diferent standards are applied; and

(7) describes any subnetworks for specialty drugs.

Kan. Admin. Regs. § 40-1-54

Authorized by K.S.A. 2022 Supp. 40-3825; implementing K.S.A. 2022 Supp. 40-3823; adopted by Kansas Register Volume 42, No. 30; effective 8/11/2023.