Louisiana Administrative Code
Title 37 - INSURANCE
Part XIII - Regulations
Chapter 185 - Regulation Number 122-Roles and Responsibilities of Pharmacy Benefit Managers and Pharmacy Services Administrative Organizations
Section XIII-18505 - Definitions

Universal Citation: LA Admin Code XIII-18505
Current through Register Vol. 50, No. 3, March 20, 2024

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.

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.

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