LD 554
pg. 2
Page 1 of 5 An Act To Protect Against Unfair Prescription Drug Practices Page 3 of 5
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LR 1315
Item 1

 
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:

 
(1)__Mail service pharmacy;

 
(2)__Claims processing, retail network management and
payment of claims to pharmacies for prescription
drugs dispensed to covered individuals;

 
(3)__Clinical management formulary development and
management services;

 
(4)__Rebate contracting and administration;

 
(5)__Certain patient compliance, therapeutic
intervention and generic substitution programs; and

 
(6)__Disease management programs.

 
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.

 
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.

 
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.

 
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.

 
C.__A pharmacy benefits manager shall notify the covered


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