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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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