(1) A pharmacy benefit manager, a third-party payer, or a discount card processor may not directly or indirectly charge or hold a pharmacy responsible for a fee, including but not limited to the following:
- (a) a fee for submission of a claim;
- (b) any other claim-related fee;
- (c) a fee for enrollment or participation in a retail pharmacy network;
- (d) a credentialing or recredentialing fee;
- (e) a fee for the development or management of claims processing services or claims payment services; or
- (f) a fee on remittance advice or a fee that is retroactive.
- (2) Only criteria established by a pharmacy performance measurement entity may be used to measure a pharmacy's performance for the purposes of this section.
- (3) A pharmacy benefits manager or third-party payer may not make or allow any reduction in payment for pharmacy services by a pharmacy benefits manager or third-party payer or directly or indirectly reduce a payment for a pharmacy service under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payments.
- (4) All reimbursements to pharmacies must be made through direct bank transfers, checks, or other payment methods that do not incur processing fees for the pharmacy. Checks must have a 180-day expiration to deposit. (Terminates June 30, 2029--sec. 8, Ch. 474, L. 2025.)
History: En. Sec. 1, Ch. 88, L. 2019; amd. Sec. 5, Ch. 474, L. 2025.