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Alabama

Provision

Statute

Cost Disclosure/Gag Clause

A.C.A. 27-45A-5 

A.C.A. 27-45A-10 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

A.C.A. 27-45-3 

Patient Steering

A.C.A. 27-45-3 

A.C.A. 27-45A-8 

Pharmacy Auditing Standards/Appeals Process

A.C.A. 34-23-184 

A.C.A. 27-45A-5 

Pharmacy Reimbursement/Claw Backs

A.C.A. 27-45A-5 

A.C.A. 27-45A-10 

Registration

Licensure

Ala. Code §27-45A-4 (2021)

Regulatory Agency/Enforcement

Ala. Code §27-45A-4 (2021)

Ala. Code §27-45A-5 (2021)

Reporting/Transparency Requirements

Ala. Code §27-45A-9 (2021)

Spread Pricing

Ala. Code §27-45A-9 (2021)

Utilization Management Tools

 

Other

 

Alaska

Provision

Statute

Cost-Disclosure/Gag-Clause 

AS 08.80.297 

Fiduciary 

 

Maximum Allowable Cost (MAC) Lists 

AAC 145.400 (Medicaid) 

AS 21.27.945 

AS 21.27.950 

Network Adequacy 

AS 21.27.945 

AS 21.27.950 

Patient Steering 

 

Pharmacy Auditing Standards/Appeals Process 

AS 21.27.910 

AS 21.27.930 

AS 21.27.950 

Pharmacy Reimbursement/Claw Backs 

 

AS 21.27.915 

AS 21.27.920 

Registration/Licensure 

A.C.A. 27-45A-4 

Regulatory Agency/Enforcement 

A.C.A. 27-45A-4 

Reporting/Transparency Requirements 

A.C.A. 27-45A-9  

 

Spread Pricing 

A.C.A. 27-45A-9  

 

Utilization Management Tools 

 

Other 

 

Arizona

Provision

Statute

Cost Disclosure/Gag Clause

A.R.S. 44-1752 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

A.R.S. 20-3331 

Network Adequacy

A.R.S. 44-1754 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

A.R.S. 44-1752 

Pharmacy Auditing Standards

Appeals Process

A.R.S. 20-3322 

 

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

A.R.S. 20-3405  (Prior Authorization) 

A.R.S. 20-3406  (Uniform Prior Authorization) 

A.R.S. 20-3653  (Step-Therapy)  

Other

 

Arkansas

Provision

Statute

Cost Disclosure/Gag Clause

A.C.A. § 23-92-507 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

A.C.A. § 17-92-507 

Network Adequacy

A.C.A. § 23-92-505 

A.C.A. § 23-92-509 

Patient Steering

 

Pharmacy Auditing Standards/Appeals Process

A.C.A. § 17-92-1201 

Pharmacy Reimbursement/Claw Backs

A.C.A. § 17-92-507 

A.C.A. § 23-92-506 

Registration/Licensure

A.C.A. § 23-92-504 

Regulatory Agency/Enforcement

A.C.A. § 23-92-508 

A.C.A. § 23-92-509 

Reporting/Transparency Requirements

A.C.A. § 23-92-505 

Spread Pricing

A.C.A. § 23-92-505 

Utilization Management Tools

A.C.A. § 23-99-1114 (Step-Therapy) 

A.C.A § 23-79-2101 (Step-Therapy) 

Other

23-92-601—23-92-606 (340B) 

California

Provision

Statute

Cost Disclosure/Gag Clause

H.S.C. 1385.003 

B.P.C. 4441 

H.S.C. 1367.207 (Cost-sharing) 

Fiduciary

H.S.C. 1385.004 

Maximum Allowable Cost (MAC) Lists

B.P.C. 4440 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

B.P.C. 4438 

Pharmacy Auditing Standards

Appeals Process

B.P.C. 4433 - 4438 

Registration/Licensure

H.S.C. 1385.0041385.005 

Regulatory Agency/Enforcement

B.P.C. 4439 

H.S.C. 1385.002 

H.S.C. 1385.006 

Reporting/Transparency Requirements

B.P.C. 44404441 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Colorado

Provision

Statute

Cost Disclosure/Gag Clause

C.R.S. 10-16-122.7 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

C.R.S. 25-37-103.5 

Network Adequacy

C.R.S. 10-16-122 

C.R.S. 24-51-1202 

C.R.S. 10-16-122.1 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

C.R.S. 10-16-122.1 

C.R.S. 10-16-122.3 

Pharmacy Auditing Standards

Appeals Process

C.R.S. 10-16-122.5 

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

C.R.S. 10-16-124.5 

C.R.S. 10-16-145 

C.R.S. 10-16-145.5 (Step Therapy) 

Other

C.R.S. 24-50-1204 (Reverse Auction) 

C.R.S. 10-16-1502 

C.R.S. 10-16-1505 (340B) 

C.R.S. 10-16-156 (Rebate pass-through) 

Connecticut

Provision

Statute

Cost Disclosure/Gag Clause

C.G.S. Sec.38a-477cc 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement/

Clawbacks

C.G.S. Sec.38a-477cc 

Pharmacy Auditing Standards

Appeals Process

C.G.S. Sec.38a-479iii 

Registration/Licensure

C.G.S. Sec.38a-479bbb 

Regulatory Agency/Enforcement

C.G.S. Sec.38a-479ccc-hhh 

C.G.S. Sec.38a-479ppp 

Reporting/Transparency Requirements

C.G.S. Sec.38a-479ppp 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Delaware

Provision

Statute

Cost Disclosure/Gag Clause

Del. Laws § 3332A 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Del. Laws § 3323A 

Network Adequacy

Del. Laws § 3362A 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Del. Laws § 3305A 

Del. Laws § 3372A 

Pharmacy Auditing Standards

Appeals Process

Del. Laws § 3304A 

Registration/Licensure

Del. Laws § 3353A 

Regulatory Agency/Enforcement

Del. Laws § 3353A 

Del. Laws § 3359A 

Del. Laws § 3373A 

Reporting/Transparency Requirements

 

Spread Pricing

Del. Laws § 3372A 

Utilization Management Tools

Del. Laws § 3336A 

Del. Laws § 3337A 

Del. Laws § 3381 

Other

 

Florida

Provision

Statute

Cost Disclosure/Gag Clause

F.S. 465.0244 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

F.S. 627.64741 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

F.S. 409.908  

(Medicaid) 

Pharmacy Auditing Standards

Appeals Process

F.S 624.491 

 

Registration/Licensure

F.S. 624.490 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

F.S. 627.42392 

Other

 

Georgia

Provision

Statute

Cost-Disclosure/Gag-Clause 

O.C.G.A. § 33-64-11 

Fiduciary 

 

Maximum Allowable Cost (MAC) or Reimbursement Lists 

O.C.G.A. § 33-64-9 

Network Adequacy 

O.C.G.A. § 33-64-10 

Patient Steering 

O.C.G.A. § 26-4-119 

O.C.G.A. § 33-64-12 

Pharmacy Reimbursement 

Clawbacks 

O.C.G.A. § 33-64-9.1 

O.C.G.A. § 33-64-11 

Pharmacy Auditing Standards 

Appeals Process 

O.C.G.A. § 26-4-118 

O.C.G.A. § 33-64-5 

O.C.G.A. § 33-64-11 

Registration/Licensure 

O.C.G.A. § 33-64-2 

Regulatory Agency/Enforcement 

O.C.G.A. § 33-64-7 

Reporting/Transparency Requirements 

O.C.G.A. § 33-64-10 

Spread Pricing 

O.C.G.A. § 33-64-10 

Utilization Management Tools 

O.C.G.A. § 33-64-4 

O.C.G.A. § 33-64-8 

Other 

 

Hawaii

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

H.R.S. §328-106 

Network Adequacy

H.R.S. §431R-2 

H.R.S. §431R-3 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

H.R.S. §431S-3 

 

Regulatory Agency/Enforcement

H.R.S. §431R-5 

H.R.S. §431R-4 

H.R.S. §431R-7 

Reporting/Transparency Requirements

H.R.S. §431R-4 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Idaho

Provision

Statute

Cost Disclosure/Gag Clause

Idaho Code § 41-349 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Idaho Code § 41-349 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

Idaho Code § 41-349 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Illinois

Provision

Statute

Cost Disclosure/Gag Clause

ILCS 5/513b1 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

ILCS 5/513b1 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

ILCS 5/513b1 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

ILCS 5/513b2 

Regulatory Agency/Enforcement

ILCS 5/513b3 

ILCS 5/513b4 

Reporting/Transparency Requirements

ILCS 5/513b3 

Spread Pricing

 

Utilization Management Tools

 

Other

215 ILCS 5/513b1 

305 ILCS 5/5-36 (340B) 

Indiana

Provision

Statute

Cost Disclosure/Gag Clause

IC 10-8-20 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

IC 27-1-24.5-23 

Network Adequacy

IC 27-1-24.5-19 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

IC 10-8-20 

IC 27-1-24.5-19 

IC 27-1-24.5-27.5 

Pharmacy Auditing Standards

Appeals Process

IC 27-1-24.5-22 

Registration/Licensure

IC 27-1-24.5-18 

Regulatory Agency/Enforcement

IC 27-1-24.5-20 

IC 27-1-24.5-20 

Reporting/Transparency Requirements

IC 27-1-24.5-21 

IC 27-1-24.5-22.5 

Spread Pricing

IC 27-1-24.5-27.5 

Utilization Management Tools

 

Other

IC 27-1-24.5-19.5  

(340B) 

 

Iowa

Provision

Statute

Cost Disclosure/Gag Clause

I.C. §510B.10 

Fiduciary

I.C. §510B.4 

Maximum Allowable Cost (MAC) Lists

I.C. §510B.8 

I.C. §510B.8A 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

I.C. §510B.10 

Pharmacy Auditing Standards

Appeals Process

I.C. §510B.8 

 

Registration/Licensure

I.C. §510B.2 

Regulatory Agency/Enforcement

I.C. §510C.2 

I.C. §510B.3 

I.C. §510B.10 

Reporting/Transparency Requirements

I.C. §510C.2 

Spread Pricing

 

Utilization Management Tools

I.C. §510B.9 

Other

 

Kansas

Provision

Statute

Cost Disclosure/Gag Clause

K.S.A. 40-3831 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

K.S.A. 40-3830 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

K.S.A. 40-3831 

 

Pharmacy Auditing Standards

Appeals Process

K.S.A. 40-3830 

 

Registration/Licensure

K.S.A. 40-3823 

Regulatory Agency/Enforcement

K.S.A. 40-3825 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Kentucky

Provision

Statute

Cost Disclosure/Gag Clause

KRS 304.17A-164 (amended by 2021 KY SB 45) 

Fiduciary

KRS 205.5512 4(c)(1) (Medicaid) 

Maximum Allowable Cost (MAC) Lists

KRS 304.17A-162 

Network Adequacy

KRS 205.5514 4(d) (Medicaid) 

Patient Steering

KRS 205.5512 4(c)(4biii, iv, v)  

(Medicaid) 

Pharmacy Reimbursement

Clawbacks

KRS 205.5512 4(c)(4bi, ii) 

(Medicaid) 

Pharmacy Auditing Standards

Appeals Process

KRS 304.17A-741 

KRS 304.17A-743 

Registration/Licensure

KRS 304.9-053 

Regulatory Agency/Enforcement

KRS 205.5510  

(Medicaid) 

KRS 205.5518 (3) (Medicaid) 

KRS 304.9-054 

KRS 304.9-440 

Reporting/Transparency Requirements

KRS 205.647  

(Medicaid) 

Spread Pricing

KRS 205.5512 4(c)(3a)(4a) (Medicaid) 

Utilization Management Tools

KRS 304.17A-163 

(Step Therapy) 

Other

 

Louisiana

Provision

Statute

Cost Disclosure/Gag Clause

RS 22:1657 

RS 22:976.1  

Fiduciary

RS 40:2870    

Maximum Allowable Cost (MAC) Lists

RS 40:2870   

Network Adequacy

RS 39:1648  

(Medicaid) 

RS 40:2870   

Patient Steering

RS 40:2870   

Pharmacy Reimbursement

Clawbacks

RS 40:2870   

Pharmacy Auditing Standards

Appeals Process

RS 40:2870   

Registration/Licensure

RS 22:1654 

RS 22:1657 

RS 40:2870      

Regulatory Agency/Enforcement

RS 22:1654 

RS 22:1657.1 

RS 22:1657.1 

Reporting/Transparency Requirements

RS 22:1657.1 

RS 40:1253.2 

RS 22:1657.1 

Spread Pricing

RS 22:1867 

RS 39:1648 

RS 40:2870   

Utilization Management Tools

RS 40:2870   

Other

RS 39:1600.1  

(Reverse Auction) 

RS 42:17.2  

(PBM Monitoring Advisory Council) 

Maine

Provision

Statute

Cost Disclosure/Gag Clause

M.R.S.A. §4349 

Fiduciary

M.R.S.A. §4349 

Maximum Allowable Cost (MAC) Lists

M.R.S.A. §4350 

Network Adequacy

M.R.S.A. §4349 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

M.R.S.A. §4349 

Pharmacy Auditing Standards

Appeals Process

M.R.S.A. §4350-C 

Registration/Licensure

M.R.S.A. §4348 

Regulatory Agency/Enforcement

M.R.S.A. §4350-C 

M.R.S.A. §4350-C 

Reporting/Transparency Requirements

M.R.S.A. §4348-A 

M.R.S.A. §4350-C 

M.R.S.A. §8732 

Spread Pricing

M.R.S.A. §4350-A 

 

Utilization Management Tools

 

Other

M.R.S.A. §4349 

(Copay accumulator) 

Maryland

Provision

Statute

Cost Disclosure/Gag Clause

M.G.S. §15–1611  

M.S.G. §15-1628  

Fiduciary

M.G.S. §15–1642 

Maximum Allowable Cost (MAC) Lists

M.G.S. §15–1628.1 

Network Adequacy

M.G.S. §15–1611.1 

Patient Steering

M.G.S. §15–1611.1 

Pharmacy Reimbursement

Clawbacks

M.G.S. §15–1612 

M.G.S. §15–1629 

M.G.S. §15–1631 

Pharmacy Auditing Standards

Appeals Process

M.G.S. §15–1628.2 

Registration/Licensure

M.G.S. §15–1604 

Regulatory Agency/Enforcement

M.G.S. §15–1604 

M.G.S. §15–1609 

M.G.S. §15–1642 

Reporting/Transparency Requirements

M.G.S. §15–1608 

M.G.S. §15–1609 

M.G.S. §15–1623 

M.G.S. §15–1624 

Spread Pricing

M.G.S. §15–1623 

M.G.S. §15–1628.3 

Utilization Management Tools

M.G.S. §15–1633 

M.G.S. §15–1634 

M.G.S. §15–1635 

M.G.S. §15–1636 

Other

M.G.S. §2–502.2  (Reverse Auction) 

M.G.S. §15-1611.2 (340B) 

Massachusetts

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

M.G.L. 1-22-175-226 

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

M.G.L. 1-22-1760-21 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Michigan

Provision

Statute

Cost Disclosure/Gag Clause

M.C.L. 550.831 

M.C.L. 550.927 

M.C.L. 333.17757 

Fiduciary

M.C.L. 550.825 

Maximum Allowable Cost (MAC) Lists

M.C.L. 550.837 

Network Adequacy

M.C.L. 550.827 

M.C.L. 550.839  

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

 

Appeals Process

M.C.L. 550.838 

M.C.L. 550.839  

Registration/Licensure

M.C.L. 550.910 

M.C.L. 550.821 

Regulatory Agency/Enforcement

M.C.L. 550.950 

M.C.L. 550.821 

M.C.L. 550.840 

M.C.L. 550.952 

Reporting/Transparency Requirements

M.C.L. 550.833 

Spread Pricing

 

Utilization Management Tools

 

Other

M.C.L. 550.829 (340B) 

M.C.L. 550.926 (340B) 

M.C.L. 333.17757b (340B) 

M.C.L. 550.839  

Minnesota

Provision

Statute

Cost Disclosure/Gag Clause

M.R.S. 62W.11 

M.R.S. 151.214 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

M.R.S. 62W.08 

Network Adequacy

M.R.S. 62W.05 

Patient Steering

M.R.S. 62W.07 

Pharmacy Reimbursement

Clawbacks

M.R.S. 62W.12 

M.R.S. 62W.13 

Pharmacy Auditing Standards

Appeals Process

M.R.S. 62W.09 

Registration/Licensure

M.R.S. 62W.03 

Regulatory Agency/Enforcement

M.R.S. 62W.03 

Reporting/Transparency Requirements

M.R.S. 62W.06 

Spread Pricing

M.R.S. 62W.06 

Utilization Management Tools

M.R.S. 62W.075 

Other

 

Mississippi

Provision

Statute

Cost Disclosure/Gag Clause

Miss. Code Ann. § 73-21-205 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Miss. Code Ann. § 73-21-156 

Network Adequacy

Miss. Code Ann. § 73-21-161 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Miss. Code Ann. § 73-21-155 

Pharmacy Auditing Standards

Appeals Process

Miss. Code Ann. § 73-21-183 

Registration/Licensure

Miss. Code Ann. § 73-21-157 

Regulatory Agency/Enforcement

Miss. Code Ann. § 73-21-155 

Miss. Code Ann. § 73-21-159 

Miss. Code Ann. § 73-21-163 

Miss. Code Ann. § 73-21-191 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Missouri

Provision

Statute

Cost Disclosure/Gag Clause

MO Rev. Stat. 376.387 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

MO Rev. Stat. 376.388 

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

MO Rev. Stat. 376.387 

 

Pharmacy Auditing Standards

Appeals Process

MO Rev. Stat. 338.600 

 

Registration/Licensure

MO Rev. Stat. 376.393 

Regulatory Agency/Enforcement

MO Rev. Stat. 376.387 

MO Rev. Stat. 376.393 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

MO Rev. Stat. 376.392 

Other

 

Montana

Provision

Statute

Cost Disclosure/Gag Clause

33-22-174 

33-2-2404 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

33-22-171-173 

Network Adequacy

33-2-2409 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

33-22-175 

33-22-176 

Pharmacy Auditing Standards

Appeals Process

33-2-177 

 

Registration/Licensure

33-2-2403 

 

Regulatory Agency/Enforcement

33-2-2403 

33-2-2411 

Reporting/Transparency Requirements

33-2-2405 

33-2-2406 

33-2-2407 

Spread Pricing

 

Utilization Management Tools

 

Other

33-2-2410 (340B) 

Nebraska

Provision

Statute

Cost Disclosure/Gag Clause

44-4606 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

44-4608 

Registration/Licensure

44-4602 

44-4605 

Regulatory Agency/Enforcement

44-4607 

44-4611 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

44-7, 111 to 44-7, 117 

Other

44-4609 (340B) 

Nevada

Provision

Statute

Cost Disclosure/Gag Clause

NRS 638A.179(1)a 

Fiduciary

NRS 638A.178 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

NRS 638A.179(1)d 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

NRS 439B.645 

Spread Pricing

 

Utilization Management Tools

 

Other

 

New Hampshire

Provision

Statute

Cost Disclosure/Gag Clause

402-N:4 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

402-N:3 

Network Adequacy

402-N:4-a 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

402-N:4 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

402-N:2 

Regulatory Agency/Enforcement

402-N:2 

402-N:7 

402-N:5  

402-N:2 

Reporting/Transparency Requirements

402-N:6 

Spread Pricing

 

Utilization Management Tools

 

Other

 

New Jersey

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

11:23-3.4 

Maximum Allowable Cost (MAC) Lists

11:4-62.3 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

11:4-62.4 

 

Registration/Licensure

11:23-2.1—11:23.6 

Regulatory Agency/Enforcement

11:4-62.5 

11:4-62.6 

11:23-3.2 

11:23-3.8 

11:23-4.1—4.3 

Reporting/Transparency Requirements

30:4D-7ee 

Spread Pricing

 

Utilization Management Tools

 

Other

5:34-5.6 (Reverse Auction) 

New Mexico

Provision

Statute

Cost Disclosure/Gag Clause

59A-61-5E(3)(b) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

59A-61-4 

Network Adequacy

59A-61-5(H) 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

59A-61-4(B) 

59A-61-7 

Pharmacy Auditing Standards

Appeals Process

59A-61-4(D)(4) 

Registration/Licensure

59A-61-3 

Regulatory Agency/Enforcement

59A-61-3 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

59A-22B-4 

59A-22B-5 

59A-22-53.1 

Other

 

New York

Provision

Statute

Cost Disclosure/Gag Clause

Public Health Law § 280-a 

Public Health Law § 4406-C 

Fiduciary

Public Health Law § 280-a  

Maximum Allowable Cost (MAC) Lists

Public Health Law § 280-a  

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Public Health Law §4406-C 

Pharmacy Auditing Standards

Appeals Process

Public Health Law § 280-a 

Public Health Law § 280-a 

Registration/Licensure

Insurance Law § 2903 

Regulatory Agency/Enforcement

Insurance Law § 2902 

Insurance Law § 2905 

Insurance Law § 2907 

Insurance Law § 2908 

Insurance Law § 2911 

Reporting/Transparency Requirements

Insurance Law § 2904 

Public Health Law § 280-a 

Spread Pricing

Public Health Law § 280-a 

Utilization Management Tools

Insurance Law § 3242 

Insurance Law § 4329 

Other

Insurance Law § 3242 

Insurance Law § 4329 (Cost-sharing/Insurance) 

North Carolina

Provision

Statute

Cost Disclosure/Gag Clause

§ 58-56A-3 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

§ 58-56A-5 

Network Adequacy

§ 58-51-37 

§ 58-56A-15 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

§ 58-56A-4 

Pharmacy Auditing Standards

Appeals Process

§ 90-85.50 

Registration/Licensure

§ 5856A2 

Regulatory Agency/Enforcement

§ 58-56A-10 

§ 58-56A-25 

§ 58-56A-30 

Reporting/Transparency Requirements

§ 5856A20 

Spread Pricing

§ 58-56A-3(b) 

Utilization Management Tools

§ 58-3-221 

Other

§ 58-51-37 (340B) 

§ 58-56A-50 (340B) 

North Dakota

Provision

Statute

Cost Disclosure/Gag Clause

19-02.1-16.1(7) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

19-02.1-14.2 

Network Adequacy

19-02.1-16.2 

Patient Steering

19-02.1-16.2 

Pharmacy Reimbursement

Clawbacks

19-02.1-16.1 

Pharmacy Auditing Standards

Appeals Process

19-03.6-02 

19-03.6-03 

Registration/Licensure

26.1-27.1-02 

Regulatory Agency/Enforcement

26.1-27.1-07 

26.1-36.10-0626.1-36.10-08 

Reporting/Transparency Requirements

26.1-36.10 

Spread Pricing

 

Utilization Management Tools

19-02.1-16.3  (Step Therapy) 

Other

19-02.1-16.5 (340B) 

Ohio

Provision

Statute

Cost Disclosure/Gag Clause

3959.20 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

3959.111 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

3959.20 

Pharmacy Auditing Standards

Appeals Process

5167.245  (Medicaid) 

3901.811 

3901.814 

Registration/Licensure

3959.05 

Regulatory Agency/Enforcement

3959.04 

3959.05 

3959.99 

5167.244  (Medicaid) 

Reporting/Transparency Requirements

5167.243  (Medicaid) 

5167.122 

Spread Pricing

Medicaid regulatory change, not legislation 

Utilization Management Tools

3923.014 

Other

5167.24 (Reverse Auction) 

Oklahoma

Provision

Statute

Cost Disclosure/Gag Clause

36 O.S. § 6962(C)(1) 

59 O.S. 359 

Fiduciary

36 O.S. §1445 

Maximum Allowable Cost (MAC) Lists

59 O.S. §360 

Network Adequacy

36 O.S. §6961 

36 O.S. § 6963(B)(4)(C) 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

36 O.S. § 6962(B)(3) 

 

Pharmacy Auditing Standards

Appeals Process

59 O.S. §§ 356.1-.356.5 

 

Registration/Licensure

59 O.S. §358 

Regulatory Agency/Enforcement

36 O.S. § 6965 

36 O.S. § 6966 

59 O.S. §358 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Oregon

Provision

Statute

Cost Disclosure/Gag Clause

735.536(2)(f) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

735.534 

Network Adequacy

735.534(2) 

Patient Steering

735.536  

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

735.534(4) 

735.542 

Registration/Licensure

735.532 

Regulatory Agency/Enforcement

735.532 

735.533-735.552 

Reporting/Transparency Requirements

(2021 OR HB 2517) 

Spread Pricing

 

Utilization Management Tools

743B.420 (Prior Authorization) 

743B.422 (Prior Authorization) 

743B.423 (Prior Authorization) 

743B.425 (Prior Authorization) 

743B.602 (Step-Therapy) 

414.772 (Step-Therapy) 

 

Other

 

Pennsylvania

Provision

Statute

Cost Disclosure/Gag Clause

2020 Act 67 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

2016 Act 169 Ch. 7 

Network Adequacy

 

Patient Steering

2020 Act 120 § 449 (2g) 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

2016 Act 169 Ch. 3  

Registration/Licensure

2016 Act 169 Ch.5 

Regulatory Agency/Enforcement

2016 Act 169 Ch.9 

Reporting/Transparency Requirements

2020 Act 120 § 449 

Spread Pricing

2020 Act 120 

Utilization Management Tools

 

Other

 

Rhode Island

Provision

Statute

Cost-Disclosure/Gag-Clause

§ 27-20.8-4  

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

§ 27-29.1-3 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

§ 5-19.1-35 

Registration/Licensure

§ 27-20.7-12 

Regulatory Agency/Enforcement

§ 27-29.1-8 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

South Carolina

Provision

Statute

Cost Disclosure/Gag Clause

§ 38-71-2150 

§ 38-71-2220 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

§ 38-71-2120 

§ 38-71-2130 

§ 38-71-2240 

Network Adequacy

§ 38-71-147 

§ 38-71-2150(2) 

§ 38-71-2230(E) 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

§ 38-71-2150(3) 

§ 38-71-2230 

 

Pharmacy Auditing Standards

Appeals Process

§ 38-71-1810 

§ 38-71-1820 

§ 38-71-2140 

Registration/Licensure

§ 38-71-2210 

Regulatory Agency/Enforcement

§ 38-71-2210 

§ 38-71-2250 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

South Dakota

Provision

Statute

Cost Disclosure/Gag Clause

58-29E-8.1 

58-33-135 

Fiduciary

58-29E-3 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

58-29E-12 

58-29E-13 

58-29F-6 

Pharmacy Auditing Standards

Appeals Process

58-29F3-F5 

58-29F-9 

Registration/Licensure

58-29E-2 

Regulatory Agency/Enforcement

58-29E-9 

Reporting/Transparency Requirements

58-17K 

58-29E-4 

Spread Pricing

 

Utilization Management Tools

 

Other

58-29E-15 (340B) 

Tennessee

Provision

Statute

Cost Disclosure/Gag Clause

§ 56-7-3114 

§ 56-7-3203 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

§ 56-7-3106 

§ 56-7-3107 

§ 56-7-3108 

Network Adequacy

 

Patient Steering

§ 56-7-3120 

Pharmacy Reimbursement

Clawbacks

§ 56-7-3104 

§ 56-7-3112 

§ 56-7-3118 

§ 56-7-3206 

Pharmacy Auditing Standards

Appeals Process

§ 56-7-3103 

§ 56-7-3206 

Registration/Licensure

§ 56-7-3113 

 

Regulatory Agency/Enforcement

§ 56-7-3113 

§ 56-7-3101 

Reporting/Transparency Requirements

§ 4-3-1021 

Spread Pricing

 

Utilization Management Tools

 

Other

§ 56-7-3119 (340B) 

Texas

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Sec. 1369.351-358 

Network Adequacy

 

Patient Steering

Sec. 1369.555 

Pharmacy Reimbursement

Clawbacks

Sec. 1369.105 

Sec. 1369.259 

Sec. 1369.266 

Sec. 1369.553 

Sec. 1369.554 

Pharmacy Auditing Standards

Appeals Process

Sec. 1369.251 

Sec. 1369.254 -2581 

Registration/Licensure

 

Regulatory Agency/Enforcement

Sec. 1369.109 

Reporting/Transparency Requirements

Sec. 1369.502 

Spread Pricing

 

Utilization Management Tools

Sec. 1369.541 

Sec. 1369.545 

Sec. 1369.546 

Other

 

Utah

Provision

Statute

Cost Disclosure/Gag Clause

31A-46-302 4(a) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

31A-46-303 

Network Adequacy

31A-46-306 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

31A-46-304 

31A-46-305 

34A-46-309 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

31A-46-201 

Regulatory Agency/Enforcement

31A-46-202 

31A-2-308 

Reporting/Transparency Requirements

31A-46-301 

31A-46-307 

Spread Pricing

 

Utilization Management Tools

 

Other

31A-46-310 (340B) 

Vermont

Provision

Statute

Cost Disclosure/Gag Clause

18 V.S.A. § 9473 (b4, b5) 

Fiduciary

18 V.S.A. § 9472 

Maximum Allowable Cost (MAC) Lists

18 V.S.A. § 9473 (c) 

Network Adequacy

8 V.S.A. § 4089j 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

18 V.S.A. § 9473 

Pharmacy Auditing Standards

Appeals Process

18 V.S.A. § 3802 

Registration/Licensure

18 V.S.A. § 9421 (a) 

Regulatory Agency/Enforcement

18 V.S.A. § 9421 (a) 

18 V.S.A. § 9421 (e) 

18 V.S.A. § 9474 

Reporting/Transparency Requirements

18 V.S.A. § 9472 

Spread Pricing

18 V.S.A. § 9421 (b) 

18 V.S.A. § 9472 

Utilization Management Tools

 

Other

18 V.S.A. 9473 (340B) 

Virginia

Provision

Statute

Cost Disclosure/Gag Clause

§ 38.2-3407.15:4 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

§ 38.2-3407.15:3 

Network Adequacy

§ 38.2-3407.7 

§ 38.2-3467(C) 

Patient Steering

§ 38.2-4312.1 

Pharmacy Reimbursement

Clawbacks

§ 38.2-3467(A)(3) 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

§ 38.2-3466 

Regulatory Agency/Enforcement

§ 38.2-3466 

§ 38.2-3469 

Reporting/Transparency Requirements

§ 38.2-3407.15:6 

§ 38.2-3468 

Spread Pricing

§ 38.2-3467(D) 

Utilization Management Tools

§ 38.2-3407.9:05 

§ 38.2-3407.15:2 

§ 38.2-3407.15:2 (Prior Authorization) 

Other

§ 38.2-3467 (340B) 

Washington

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

RCW 19.340.100 

RCW 48.200.280 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

RCW 19.340.100 (H)-(l) 

Pharmacy Auditing Standards

Appeals Process

RCW 19.340.040 

RCW 19.340.050 

RCW 19.340.060 

RCW 19.340.070 

RCW 19.340.080 

RCW 48.200.220 

RCW 48.200.230 

RCW 48.200.240 

RCW 48.200.250 

RCW 48.200.260 

Registration/Licensure

RCW 19.340.030 

RCW 48.200.030 

Regulatory Agency/Enforcement

RCW 48.200.030 

RCW 48.200.900 

RCW 19.340.110 

RCW 48.200.050 

RCW 48.200.290 

Reporting/Transparency Requirements

RCW 43.71C.030 

Spread Pricing

 

Utilization Management Tools

 

Other

RCW. 48.43.435 (Copay accumulator) 

West Virginia

Provision

Statute

Cost Disclosure/Gag Clause

§33-51-9(a) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

§33-51-8(d) 

Patient Steering

§33-51-11 

Pharmacy Reimbursement

Clawbacks

§5-16-7G(i) This law is specific to cost-sharing requirements for insulin. 

§33-51(9b) 

Pharmacy Auditing Standards

Appeals Process

§33-51-4 

§33-51-5 

§33-51-6 

Registration/Licensure

§33-51-7 

§33-51-8 (c) 

Regulatory Agency/Enforcement

§33-51-8(a) 

§33-51-8(e) 

§33-51-10 

Reporting/Transparency Requirements

§5-16-9(i) 

§33-51-12 

Spread Pricing

 

Utilization Management Tools

 

Other

§33-51-9(d) (340B) 

Wisconsin

Provision

Statute

Cost Disclosure/Gag Clause

632.861(2)(a) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

632.865 

Network Adequacy

632.865 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

632.865 

 

Pharmacy Auditing Standards

Appeals Process

632.865 

 

Registration/Licensure

633.14 

Regulatory Agency/Enforcement

633.17 

Reporting/Transparency Requirements

632.865(7) 

Spread Pricing

 

Utilization Management Tools

632.853  

632.866 (Step-Therapy) 

Other

 

Wyoming

Provision

Statute

Cost Disclosure/Gag Clause

26-52-104(j) 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

26-52-104 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

26-52-103 

Registration/Licensure

26-52-101 

Regulatory Agency/Enforcement

26-52-101 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

District of Columbia

Provision

Statute

Cost Disclosure/Gag Clause

D.C. Code Ann. § 48–832.01

Fiduciary

D.C. Code Ann. § 48–832.01

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

D.C. Code Ann. § 48–832.01

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

 

Regulatory Agency/Enforcement

D.C. Code Ann. § 48–832.03

Reporting/Transparency Requirements

 

Spread Pricing

D.C. Code Ann. § 48–832.01

Utilization Management Tools

 

Other

 

Puerto Rico

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

P.R. Laws tit. 26, § 9049 (Insurer Oversight)

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

P.R. Laws tit. 26, § 9046 (Formularies)

P.R. Laws tit. 26 § 9047 (Step Therapy)

Other

 

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