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income, long-term care or other limited benefit health | | insurance policies and contracts. |
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| | | B.__"Covered individual" means a member, participant, | | enrollee, contract holder or policy holder or beneficiary of | | a covered entity who is provided health coverage by the | | covered entity.__"Covered individual" includes a dependent | | or other person provided health coverage through a policy, | | contract or plan for a covered individual. |
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| | | C.__"Generic drug" means a chemically equivalent copy of a | | brand-name drug with an expired patent. |
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| | | D.__"Labeler" means an entity or person that receives | | prescription drugs from a manufacturer or wholesaler and | | repackages those drugs for later retail sale and that has a | | labeler code from the federal Food and Drug Administration | | under 21 Code of Federal Regulations, 270.20 (1999). |
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| | | E.__"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 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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| | | F.__"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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