Section 304.17A-161 - Definitions for KRS 304.17A-161, 304.17A-162, 304.17A-163, and 304.17A-165As used in this section and KRS 304.17A-162, 304.17A-163, and 304.17A-165 unless the context requires otherwise:
(1) "Contracted pharmacy" or "pharmacy" means a pharmacy located in Kentucky participating in the network of a pharmacy benefit manager through a direct contract or through a contract with a pharmacy services administration organization or group purchasing organization;(2) "Drug product reimbursement" means the amount paid by a pharmacy benefit manager to a contracted pharmacy for the cost of the drug dispensed to a patient and does not include a dispensing or professional fee;(3) "Maximum allowable cost" means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a generic drug and does not include a dispensing or professional fee; and(4) "Pharmacy benefit manager" means an entity that, on behalf of a health benefit plan, state agency, insurer, managed care organization providing services under KRS Chapter 205, or other third-party payor:(a) Contracts directly or indirectly with pharmacies to provide prescription drugs to individuals;(b) Administers a prescription drug benefit;(c) Processes or pays pharmacy claims;(d) Creates or updates prescription drug formularies;(e) Makes or assists in making prior authorization determinations on prescription drugs;(f) Administers rebates on prescription drugs; or(g) Establishes a pharmacy network.Amended by 2016 Ky. Acts ch. 79,§ 5, eff. 7/14/2016.Added by 2013 Ky. Acts ch. 109,§ 1, eff. 6/24/2013.