Louisiana Administrative Code
Title 37 - INSURANCE Part
Part XIII - Regulations
Chapter 185 - Regulation Number 122-Roles and Responsibilities of Pharmacy Benefit Managers and Pharmacy Services Administrative Organizations
Section XIII-18509 - Roles and Responsibilities of Pharmacy Services Administrative Organizations

Universal Citation: LA Admin Code XIII-18509

Current through Register Vol. 50, No. 9, September 20, 2024

A. The roles and responsibilities solely within the purview of pharmacy services administrative organizations are as follows:

1. negotiating contracts, drug reimbursement rates, payments, and audit terms on behalf of pharmacy clients with pharmacy benefit managers;

2. billing and collecting payments from payers on behalf of pharmacies;

3. using contractual agreements to develop networks of member pharmacies. These agreements generally authorize pharmacy services administrative organizations to interact with third-party payers and pharmacy benefit managers;

4. negotiating access for pharmacies to networks and patients;

5. facilitating the purchase of prescription drugs and other medical products from drug manufacturers and providing for delivery to pharmacies for dispensing; and

6. assisting pharmacy clients with business strategy, pricing appeals, claims reconciliation, and certification and credentialing requirements.

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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