New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XXII
Part 452 - General Duties, Accountability, and Transparency Provision For Pharmacy Benefit Managers
Section 452.3 - Terms and conditions of contract relating to pharmacy benefit management services provided to health plans
Universal Citation: 452 NY Comp Codes Rules and Regs ยง 452.3
Current through Register Vol. 46, No. 39, September 25, 2024
(a) The disclosures provided for by Public Health Law section 280-a(2)(d) shall:
(1) be made by the pharmacy benefit manager
within 30 days from receipt of a written request from the health plan, but such
request shall not be made by the health plan more than once every six
months;
(2) require that the
contracts or arrangements requested be provided to the health plans in full and
unredacted; and
(3) not apply to
health plans that provide workers' compensation or automobile
insurance.
(b) In the event that a health plan requests disclosure of a contract or arrangement that the pharmacy benefit manager determines is not related to the pharmacy benefit management services provided to the health plan, or that the pharmacy benefit manager determines contains information that is confidential, the pharmacy benefit manager may appeal to the department for a determination on disclosure.
(1) Application for a determination on
disclosure. A pharmacy benefit manager shall file a letter setting forth all
the relevant facts and circumstances that the department should consider in
making the determination within 30 days from receipt of the written request
from the health plan by sending such letter by electronic mail to the
department at the address listed on the website of the department for such
purpose. Such application shall also contain a copy of the unredacted contract
that is at issue.
(2) Stay of
obligation. Upon the filing of a complete application for a determination on
disclosure, the obligation to respond to the health plan is stayed until a
determination is rendered. An incomplete application shall have no such
effect.
(3) Determination on
disclosure. Upon receipt of a complete application, the department may seek
additional information from the pharmacy benefit manager, the health plan, or
any other party. Once the department determines that the department has
sufficient information to render a determination, such determination shall be
made in writing to the pharmacy benefit manager, and may direct the pharmacy
benefit manager:
(i) to make the
disclosure;
(ii) that it is not
required to make the disclosure and to instead send a copy of the department's
determination to be transmitted to the health plan; or
(iii) to make the disclosure with specific
redactions.
(4)
Information obtained by the department under this section shall be treated as
information obtained under Insurance Law section 2904.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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