New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XXII
Part 452 - General Duties, Accountability, and Transparency Provision For Pharmacy Benefit Managers
Section 452.2 - Health plan right to an accounting
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Pharmacy benefit managers that provide pharmacy benefit management services only for health plans that provide workers' compensation or automobile insurance are exempt from the requirements listed in Public Health Law section 280-a(2)(b) and (c).
(b) Upon written request of any health plan for which the pharmacy benefit manager provides pharmacy benefit management services, a pharmacy benefit manager shall provide an accounting of all funds received by the pharmacy benefit manager for pharmacy benefit management services attributable to the health plan sufficient to demonstrate that such funds were used or distributed only pursuant to the pharmacy benefit manager's contract with the health plan or applicable law.
(c) Each pharmacy benefit manager shall have in place accounting measures, practices, and procedures that will permit such an accounting to each health plan for which it performs pharmacy benefit management services.
(d) A pharmacy benefit manager shall have a commercially reasonable time of not more than 60 days to produce the accounting to the health plan.
