La. Admin. Code tit. 37 § XIII-18507

Current through Register Vol. 50, No. 11, November 20, 2024

Section XIII-18507 - Roles and Responsibilities of Pharmacy Benefit Managers

A. The roles and responsibilities solely within the purview of pharmacy benefit managers are as follows:

1. administering prescription drug plans for health plan sponsors;

2. formulary and benefit design support and management;

3. establishing reimbursement rates and making payments on behalf of health plan sponsors;

4. establishing and managing pharmacy networks to ensure network adequacy on behalf of health plans;

5. performing drug utilization management;

6. administering disease management and drug adherence programs; and

7. negotiating rebates and discounts from drug manufacturers.

La. Admin. Code tit. 37, § XIII-18507

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.