Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 44.00 - Confidentiality Of Bids Submitted For Restricted Pharmacy Network Contracts - To Facilitate The Implementation Of M.g.l. C.176d, Section 3b
Section 44.03 - Definitions

Carrier:an insurer operating pursuant to the provisions of M.G.L. c. 175, a hospital service corporation operating pursuant to the provisions of M.G.L. c. 176A, a medical service corporation operating pursuant to the provisions of M.G.L. c. 176B, a health maintenance organization operating pursuant to the provisions of M.G.L. c. 176G, and a preferred provider arrangement operating pursuant to the provisions of M.G.L. c. 176I, or a wholly-owned subsidiary or affiliate under common ownership thereof.

Commissioner: the Commissioner of Insurance appointed pursuant to M.G.L. c. 26, § 6, or his or her designee.

Eligible Bidder: a retail pharmacy, community pharmacy or pharmacy department registered pursuant to M.G.L. c. 112, §§ 38 and 39, or an association of such pharmacies, irrespective of corporate structure or number of locations at which it conducts business, located within the Geographical Service Area of a Carrier and willing to bid for participation in a Restricted Pharmacy Network contract.

Geographical Service Area: that area defined in the terms of a Carrier's certificate, contract or agreement of insurance or coverage. If the Carrier's certificate, contract or agreement of insurance does not define a specific geographic area, then it shall be deemed to be the entire State.

Insured: a person whose health care services and benefits are provided by, or indemnified by or otherwise covered by a Carrier's group or individual insurance policy, or certificate, agreement or contract and shall include subscribers, enrollees or members.

Restricted Pharmacy Network: an arrangement for the provision of pharmaceutical drug benefits to Insureds which under the terms of a Carrier's policy, certificate, contract or agreement of insurance or coverage requires an Insured, or creates a financial incentive for an Insured, to obtain prescription drug benefits from one or more participating pharmacies that have entered into a specific contractual relationship with the Carrier pursuant to a competitive bidding process.

Willing Pharmacy Provider: a retail pharmacy registered pursuant to M.G.L. c. 112, §§ 38 and 39, or an association of such pharmacies whose purpose is to promote participation in Restricted Pharmacy Networks, irrespective of corporate structure or number of locations at which it conducts business, located within the Geographical Service Area of a Carrier and which are not offered or are not participating in a Carrier's Restricted Pharmacy Network contract but are willing to provide drug benefits to the Carrier's Insureds in accordance with M.G.L. c. 176D, § 3B.