La. Admin. Code tit. 37 § XIII-18505

Current through Register Vol. 50, No. 11, November 20, 2024
Section XIII-18505 - Definitions

Pharmacy Benefit Manager-a person, business, or other entity and any wholly or partially owned or controlled subsidiary of such entity that either directly or through an intermediary manages or administers the prescription drug and device portion of one or more health benefit plans on behalf of a third party, including insurers, plan sponsors, insurance companies, unions, and health maintenance organizations, in accordance with a pharmacy benefit management plan. The management or administration of a plan may include but is not limited to review, processing of drug prior authorization requests, adjudication of appeals and grievances related to the prescription drug benefit, contracting with network pharmacies, and controlling the cost of covered prescription drugs.

Pharmacy Services Administrative Organization-an entity that provides a contracted pharmacy with administrative, contracting, or payment services relating to prescription drug benefits.

La. Admin. Code tit. 37, § XIII-18505

Promulgated by the Department of Insurance, Office of the Commissioner, LR 482300 (9/1/2022).
AUTHORITY NOTE: Promulgated in accordance with R.S. 22:11, R.S. 22:1641(8), R.S. 22:1655, R.S. 22:1660.1(B)(1), R.S. 22:1660.8, R.S. 22:1660.9(C) and the Administrative Procedure Act, R.S. 49:950 et seq.