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F.__"Pharmacy benefits management" means the procurement of | | prescription drugs at a negotiated rate for dispensation | | within this State to covered individuals, the | | administration or management of prescription drug benefits | | provided by a covered entity for the benefit of covered | | individuals or any of the following services provided with | | regard to the administration of pharmacy benefits: |
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| | | (1)__Mail service pharmacy; |
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| | | (2)__Claims processing, retail network management and | | payment of claims to pharmacies for prescription | | drugs dispensed to covered individuals; |
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| | | (3)__Clinical management formulary development and | | management services; |
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| | | (4)__Rebate contracting and administration; |
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| | | (5)__Certain patient compliance, therapeutic | | intervention and generic substitution programs; and |
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| | | (6)__Disease management programs. |
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| | | G.__"Pharmacy benefits manager" means an entity that | | performs pharmacy benefits management.__"Pharmacy benefits | | manager" includes a person or entity acting for a pharmacy | | benefits manager in a contractual or employment | | relationship in the performance of pharmacy benefits | | management for a covered entity and includes mail service | | pharmacy. |
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| | | 2. Required practices.__A pharmacy benefits manager owes a | | fiduciary duty to a covered entity and covered individuals and | | shall discharge that duty in accordance with the provisions of | | ERISA, state and federal law and this section. |
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| | | A.__A pharmacy benefits manager shall perform its duties | | with care, skill, prudence and diligence and in accordance | | with the standards of conduct applicable to a fiduciary in | | an enterprise of a like character and with like aims. |
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| | | B.__A pharmacy benefits manager shall discharge its duties | | with respect to the covered entity and covered individuals | | solely in the interests of the covered individuals and for | | the primary purpose of providing benefits to covered | | individuals and defraying reasonable expenses of | | administering health plans. |
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| | | C.__A pharmacy benefits manager shall notify the covered |
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