- (a) Every health carrier that provides prescription benefits as a covered benefit under a health benefit plan shall ensure that prescription benefit claims are adjusted and paid in accordance with the requirements of Ins 1001 and RSA 420-J:8-a.
(b) Any health carrier or PBM shall require all participating pharmacies to charge any covered person the lesser of:
- (1) The pharmacy’s usual and customary price for filling the prescription; or
- (2) The contracted copayment.
- (c) The health carrier or PBM shall not be in violation of this section when the conditions set forth in RSA 420-J:8-a, IV exist or the claim has been submitted fraudulently or with inaccurate or misrepresented information.
Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20