TITLE 33. INSURANCE AND INSURANCE COMPANIES

CHAPTER 22. DISABILITY INSURANCE

Part 1. General Provisions

Maximum Allowable Cost List -- Price Formulation, Updating, And Disclosure -- Exceptions

33-22-172. Maximum allowable cost list -- price formulation, updating, and disclosure -- exceptions. (1) At the time it enters into a contract with a pharmacy and subsequently upon request, a plan sponsor or pharmacy benefit manager shall provide the pharmacy with the sources used to determine the pricing for the maximum allowable cost list.

(2) A plan sponsor or pharmacy benefit manager shall:

(a) review and update the price information for each drug on the maximum allowable cost list at least once every 10 calendar days to reflect any modification of pricing;

(b) establish a process for eliminating products from the maximum allowable cost list or modifying the prices in the maximum allowable cost list in a timely manner to remain consistent with pricing changes and product availability in the marketplace; and

(c) provide a process for each pharmacy to readily access the maximum allowable cost list specific to the pharmacy in a searchable and usable format.

History: En. Sec. 3, Ch. 431, L. 2015.