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Alabama

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ala. Code § 27-45A-10 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

Ala. Code § 27-45-3 

Patient Steering Provisions

Ala. Code § 27-45-3

Ala. Code § 27-45A-8

Pharmacy Auditing Standards and Appeals Process

Ala. Code § 34-23-184

Pharmacy Reimbursement and Claw Backs

Ala. Code § 27-45A-10 

Registration and Licensure

Ala. Code § 27-45A-4

Regulatory Agency and Enforcement

Ala. Code § 27-45A-4

Ala. Code § 27-45A-5

Transparency and Reporting Requirements

Ala. Code §27-45A-9

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Alaska

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Alaska Stat. § 08.80.297 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Alaska Stat. § 21.27.945 

Alaska Stat. § 21.27.950

Alaska Admin. Code § 145.400 (Medicaid) 

Network Adequacy Requirement

Alaska Stat. § 21.27.945

Alaska Stat. § 21.27.950 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Alaska Stat. § 21.27.910 

Alaska Stat. § 21.27.930 

Alaska Stat. § 21.27.950 

Pharmacy Reimbursement and Claw Backs

Alaska Stat. § 21.27.915 

Alaska Stat. § 21.27.920

Alaska Admin. Code § 145.400 (Medicaid) 

Registration and Licensure

 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Arizona

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ariz. Rev. Stat. § 44-1752 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Ariz. Rev. Stat. § 20-3331 

Network Adequacy Requirement

Ariz. Rev. Stat. § 44-1754 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Ariz. Rev. Stat. § 44-1752 

Pharmacy Reimbursement and Claw Backs

Ariz. Rev. Stat. § 20-3322 

 

Registration and Licensure

(2023 SB 1382) Ariz. Rev. Stat. 20-3333

Regulatory Agency and Enforcement

(2023 SB 1382) Ariz. Rev. Stat. 20-3333

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

Ariz. Rev. Stat. § 22-1126 (Copay Accumulator)

Ariz. Rev. Stat. § 20-3405 (Prior Authorization) 

Ariz. Rev. Stat. § 20-3406 (Uniform Prior Authorization) 

Ariz. Rev. Stat. § 20-3653 (Step-Therapy)

Other

 

Arkansas

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ark. Code Ann. § 23-92-507 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Ark. Code Ann. § 17-92-507

Network Adequacy Requirement

Ark. Code Ann. § 23-92-505 

Ark. Code Ann. § 23-92-509 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Ark. Code Ann. § 17-92-1201 

Pharmacy Reimbursement and Claw Backs

Ark. Code Ann. § 23-92-506 

Ark. Code Ann. § 17-92-507 

Ark. Code Ann. § 17-92-1201 

Registration and Licensure

Ark. Code Ann. § 23-92-504 (a) 

Regulatory Agency and Enforcement

Ark. Code Ann. § 23-92-508 

Ark. Code Ann. § 23-92-509

(2023 AR S 94) Ark. Code § 23-92-504(b)

Transparency and Reporting Requirements

Ark. Code Ann. § 23-92-505 

Spread Pricing Restrictions

Ark. Code Ann. § 23-92-505 

Utilization Management Tools

Ark. Code Ann. § 23-79-2101 (Step-therapy)

Ark. Code Ann. § 23-99-1114 (Step-therapy)

Other

Ark. Code Ann. § 23-79-2303 (Copay Accumulator)

Ark. Code Ann. § 23-92-601—23-92-606 (340B)

Ark. Code Ann. § 23-99-1503 (White-Bagging)

(2023 AR H 1481) Ark. Code § 23-79-2503 (Rebate Pass-Through)

California

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

CA Health &Safety Code § 1367.207 

CA Health & Safety Code § 1385.003 

CA Bus & Prof Code § 4441 

Fiduciary Responsibility

CA Health & Safety Code § 1385.004 

Maximum Allowable Cost (MAC) Lists

CA Bus &Prof Code § 4440 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

CA Bus & Prof Code § 4434

CA Bus & Prof Code § 4435

CA Bus & Prof Code § 4436

CA Bus & Prof Code § 4437

CA Bus & Prof Code § 4438 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

CA Health & Safety Code § 1385.004

CA Health & Safety Code § 1385.005 

Regulatory Agency and Enforcement

CA Health & Safety Code § 1385.002 

CA Health & Safety Code § 1385.006

Transparency and Reporting Requirements

CA Bus & Prof Code § 4441 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

2023 S 786

Colorado

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Colo. Rev. Stat. § 10-16-122.7 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Colo. Rev. Stat. § 25-37-103.5 

Network Adequacy Requirement

Colo. Rev. Stat. § 10-16-122.1 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Colo. Rev. Stat. § 10-16-122.5 

Pharmacy Reimbursement and Claw Backs

Colo. Rev. Stat. § 10-16-122.3 

Registration and Licensure

(2023 H 1227) Colo. Rev. Stat § 10-16-122.2.5

Regulatory Agency and Enforcement

(2023 H 1227) Colo. Rev. Stat § 10-16-122.2.5

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

Colo. Rev. Stat. § 10-16-122.4 (Non-Medical Switching)

Colo. Rev. Stat. § 10-16-124.5 (Prior Authorization)

Colo. Rev. Stat. § 10-16-145 (Step Therapy) 

Colo .Rev. Stat. § 10-16-145.5 (Step-Therapy and Prior Authorization for Cancer Drugs) 

Other

Colo. Rev. Stat. § 24-50-1204 (Reverse Auction) 

Colo. Rev. Stat. § 10-16-1502 (340B)

Colo. Rev. Stat. § 10-16-1505 (340B) 

Colo. Rev. Stat. § 10-16-156 (Rebate Pass-Through) 

(2023 CO S 195) Colo. Rev. Stat. § 10-16-161 (Copay Accumulator)

Connecticut

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Conn. Gen. Stat. § 38a-477cc 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Conn. Gen. Stat. § 38a-479iii 

Pharmacy Reimbursement and Claw Backs

Conn. Gen. Stat. § 38a-477cc 

Registration and Licensure

Conn. Gen. Stat. § 38a-479bbb 

Regulatory Agency and Enforcement

Conn. Gen. Stat. § 38a-479ccc-hhh 

Conn. Gen. Stat. § 38a-479ppp 

Transparency and Reporting Requirements

Conn. Gen. Stat. § 38a-479ppp

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

2023 H 6669 (340B)

Conn. Gen. Stat. § 38a-478w (Copay Accumulator)

Delaware

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Del. Code tit. 18 § 3332A 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Del. Code tit. 18 § 3323A 

Network Adequacy Requirement

Del. Code tit. 18 § 3362A 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Del. Code tit. 18 § 3304A

Del. Code tit. 18 § 3308A

Del. Code tit. 18 § 3372A 

Pharmacy Reimbursement and Claw Backs

Del. Code tit. 18 § 3305A

Registration and Licensure

Del. Code tit. 18 § 3353A 

Regulatory Agency and Enforcement

Del. Code tit. 18 § 3353A 

Del. Code tit. 18 § 3359A 

Del. Code tit. 18 § 3373A 

Transparency and Reporting Requirements

Del. Code tit. 18 § 3363A

Spread Pricing Restrictions

Del. Code tit. 18 § 3372A 

Utilization Management Tools

Del. Code tit. 18 § 3336A (Prior Authorization)

Del. Code tit. 18 § 3337A (Prior Authorization)

Del. Code tit. 18 § 3372 (Prior Authorization)

Other

Del. Code tit. 18 § 3382 (Copay Accumulator)

Florida

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Fla. Stat. § 465.0244 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Fla. Stat. § 627.64741 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Fla. Stat. § 409.908 (Medicaid) 

Pharmacy Reimbursement and Claw Backs

Fla .Stat. § 624.491 

Registration and Licensure

Fla. Stat. § 624.490 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

Fla. Stat. § 627.42392 (Prior Authorization)

Other

 

Georgia

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ga. Code Ann. § 33-64-11

 Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Ga. Code Ann. § 33-64-9

Network Adequacy Requirement

 

Patient Steering Provisions

Ga. Code Ann. § 26-4-119

Ga. Code Ann. § 33-64-11

Ga. Code Ann. § 33-64-12

Pharmacy Auditing Standards and Appeals Process

Ga. Code Ann. § 26-4-118

Ga. Code Ann. § 33-64-9

Ga. Code Ann. § 33-64-11

Pharmacy Reimbursement and Claw Backs

Ga. Code Ann. § 26-4-118

Ga. Code Ann. § 33-64-9.1

Ga. Code Ann. § 33-64-11

Registration and Licensure

Ga. Code Ann. § 33-64-3

Ga. Code Ann. § 33-64-2

Regulatory Agency and Enforcement

Ga. Code Ann. § 33-64-7

Ga. Code Ann. § 33-64-12

Transparency and Reporting Requirements

Ga. Code Ann. § 33-64-10

Spread Pricing Restrictions

Ga. Code Ann. § 33-64-10

Utilization Management Tools

Ga. Code Ann. § 33-64-4

Ga. Code Ann. § 33-64-8 (Prior Authorization)

Other

Ga. Code Ann. § 33-64-10 (Rebate Pass-Through)

Ga. Code Ann. § 33-64-10 (Copay Accumulator)

Hawaii

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

2023 S 1381 (Repeals Haw. Rev. Stat. § 328-106)

Network Adequacy Requirement

Haw. Rev. Stat. § 431R-2 

Haw. Rev. Stat. § 431R-3 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

Haw. Rev. Stat. § 431S-3 

Regulatory Agency and Enforcement

Haw. Rev. Stat. § 431R-4 

Haw. Rev. Stat. § 431R-5 

Haw. Rev. Stat. § 431R-7 

Transparency and Reporting Requirements

Haw. Rev. Stat. § 431R-4 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Idaho

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Idaho Code Ann. § 41-349

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Idaho Code Ann. § 41-349 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

Idaho Code Ann. § 41-349 

Registration and Licensure

Idaho Code Ann. § 41-349

Regulatory Agency and Enforcement

(2023 H 215) Idaho Code Ann. § 41-4-349

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Illinois

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

215 Ill. Comp. Stat. § 5/513b1 

(2023 H 3631) (prevents retaliation)

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

215 Ill. Comp. Stat. § 5/513b1

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

215 Ill. Comp. Stat. § 5/513b1 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

215 Ill. Comp. Stat. § 5/513b2

Regulatory Agency and Enforcement

215 Ill. Comp. Stat. § 5/513b3 

215 Ill. Comp. Stat. § 5/513b4 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

215 Ill. Comp. Stat. § 5/513b1 (340B)

215 Ill. Comp. Stat. § 134/30d (Copay Accumulator)

305 Ill. Comp. Stat. § 5/5-36 (Medicaid managed care PBM contract provisions)

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

215 Ill. Comp. Stat. § 5/513b1 

(2023 H 3631) (prevents retaliation)

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

215 Ill. Comp. Stat. § 5/513b1

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

215 Ill. Comp. Stat. § 5/513b1 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

215 Ill. Comp. Stat. § 5/513b2

Regulatory Agency and Enforcement

215 Ill. Comp. Stat. § 5/513b3 

215 Ill. Comp. Stat. § 5/513b4 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

215 Ill. Comp. Stat. § 5/513b1 (340B)

215 Ill. Comp. Stat. § 134/30d (Copay Accumulator)

305 Ill. Comp. Stat. § 5/5-36 (Medicaid managed care PBM contract provisions)

Indiana

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ind. Code § 5-10-8-20 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Ind. Code § 27-1-24.5-23 

Network Adequacy Requirement

Ind. Code § 27-1-24.5-19 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Ind. Code § 27-1-24.5-22 

Ind. Code § 27-1-24.5-27.5 

Pharmacy Reimbursement and Claw Backs

Ind. Code § 27-1-24.5-19 

Ind. Code § 27-1-24.5-22 

Ind. Code § 27-1-24.5-27.5 

Registration and Licensure

Ind. Code § 27-1-24.5-18

Regulatory Agency and Enforcement

Ind. Code § 27-1-24.5-20 

Transparency and Reporting Requirements

Ind. Code § 27-1-24.5-21 

Ind. Code § 27-1-24.5-22.5 

2023 S 8 (Transparency Requirements) 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

Ind. Code § 27-1-24.5-19.5

(340B) 

2023 S 8 (Rebate Pass-Through) 

2023 H 1445 (Audit by State Attorney General)

Iowa

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Iowa Code § 510B.10

Fiduciary Responsibility

Iowa Code § 510B.4 

Maximum Allowable Cost (MAC) Lists

Iowa Code § 510B.8 

Iowa Code § 510B.8A 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Iowa Code § 510B.10 

Pharmacy Reimbursement and Claw Backs

Iowa Code § 510B.8 

 

Registration and Licensure

Iowa Code § 510B.2 

Regulatory Agency and Enforcement

Iowa Code § 510B.3 

Iowa Code § 510B.10 

Transparency and Reporting Requirements

Iowa Code § 510C.2 

Spread Pricing Restrictions

 

Utilization Management Tools

Iowa Code § 510B.9 (Prior Authorization)

Iowa Code § 505.26 (Prior Authorization)

Other

2023 H 423 (340B)

Iowa Code § 510B.10 (copay accumulator)

Kansas

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Kan. Stat. Ann. § 40-3831 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Kan. Stat. Ann. § 40-3830 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Kan. Stat. Ann. § 40-3830 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

Kan. Stat. Ann. § 40-3823 

Regulatory Agency and Enforcement

Kan. Stat. Ann. § 40-3825 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Kentucky

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ky. Rev. Stat. Ann. § 304.17A-164 

(amended by 2021 KY SB 45

Fiduciary Responsibility

Ky. Rev. Stat. Ann. § 205.5512 4(c)(1) 

(Medicaid) 

Maximum Allowable Cost (MAC) Lists

Ky. Rev. Stat. Ann. § 304.17A-162 

Network Adequacy Requirement

Ky. Rev. Stat. Ann. § 205.5514 4(d) (Medicaid) 

Patient Steering Provisions

Ky. Rev. Stat. Ann. § 205.5512 4(c)(4biii, iv, v)(Medicaid) 

Pharmacy Auditing Standards and Appeals Process

Ky. Rev. Stat. Ann. § 205.5512 4(c)(4bi, ii) (Medicaid) 

Pharmacy Reimbursement and Claw Backs

Ky. Rev. Stat. Ann. § 304.17A-741 

Ky. Rev. Stat. Ann. § 304.17A-743 

Registration and Licensure

Ky. Rev. Stat. Ann. § 304.9-053 

Regulatory Agency and Enforcement

Ky. Rev. Stat. § 205.5510(Medicaid) 

Ky. Rev. Stat. Ann. § 205.5518 (3)(Medicaid) 

Ky. Rev. Stat. Ann. § 304.9-054 

Ky. Rev. Stat. Ann. § 304.9-440 

Transparency and Reporting Requirements

Ky. Rev. Stat. Ann. § 205.647(Medicaid) 

Spread Pricing Restrictions

Ky. Rev. Stat. Ann. § 205.5512 4(c)(3a)(4a)(Medicaid) 

Utilization Management Tools

Ky. Rev. Stat. Ann. § 205.5632 (Prior Authorization)

Ky. Rev. Stat. Ann. § 304.17A-163 (Step Therapy) 

Other

Ky. Rev. Stat. Ann. § 205.5512 (1) (Single PBM Contract for Medicaid MCOs)

Ky. Rev. Stat. Ann. § 304.17A-164 (Copay Accumulator)

Louisiana

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

La. Stat. Ann. § 22:1657

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

La. Stat. Ann. § 22:1863

La. Stat. Ann. § 22:1864

La. Stat. Ann. § 40:2870 

Network Adequacy Requirement

La. Stat. Ann. § 39:1648 (Medicaid) 

La. Stat. Ann. § 40:2870

Patient Steering Provisions

La. Stat. Ann. § 40:2870 

Pharmacy Auditing Standards and Appeals Process

La. Stat. Ann. § 22:1865

La. Stat. Ann. § 40:2870

Pharmacy Reimbursement and Claw Backs

La. Stat. Ann. § 40:2870 

Registration and Licensure

La. Stat. Ann. § 22:1651

La. Stat. Ann. § 22:1657 

Regulatory Agency and Enforcement

La. Stat. Ann. § 22:1654 

Transparency and Reporting Requirements

La. Stat. Ann. § 22:1657.1 

La. Stat. Ann. § 40:1253.2 (Medicaid)

Spread Pricing Restrictions

La. Stat. Ann. § 22:1867 

La. Stat. Ann. § 39:1648 (Medicaid)

La. Stat. Ann. § 40:2870 

Utilization Management Tools

La. Stat. Ann. § 40:2870 (Step-Therapy)

Other

La. Stat. Ann. § 22:976.1 (Copay Accumulator)

La. Stat. Ann. § 22:1020.53 (White-Bagging)

La. Stat. Ann. § 39:1600.1 (Reverse Auction) 

La. Stat. Ann. § 40:2869 (PBM Monitoring Advisory Council)

Maine

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Me. Rev. Stat. Ann. tit. 22 § 4349 

Fiduciary Responsibility

Me. Rev. Stat. Ann. tit. 22 § 4349 

Maximum Allowable Cost (MAC) Lists

Me. Rev. Stat. Ann. tit. 22 § 4350 

Network Adequacy Requirement

Me. Rev. Stat. Ann. tit. 22 § 4349 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Me. Rev. Stat. Ann. tit. 22 § 4350-C 

Pharmacy Reimbursement and Claw Backs

Me. Rev. Stat. Ann. tit. 22 § 4349 

Me. Rev. Stat. Ann. tit. 22 § 4350-C 

Registration and Licensure

Me. Rev. Stat. Ann. tit. 22 § 4348 

Regulatory Agency and Enforcement

Me. Rev. Stat. Ann. tit. 22 § 4348 

Transparency and Reporting Requirements

Me. Rev. Stat. Ann. tit. 22 § 8732

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

Me. Rev. Stat. Ann. tit. 22 § 4349 (Copay Accumulator) 

Maryland

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Md. Code Ins. Law § 15–1611

Md. Code Ins. Law § 15-1628

Fiduciary Responsibility

Md. Code Ins. Law § 15–1642 

Maximum Allowable Cost (MAC) Lists

Md. Code Ins. Law § 15–1628.1 

Network Adequacy Requirement

Md. Code Ins. Law § 15-1628

Patient Steering Provisions

Md. Code Ins. Law § 15–1611.1 

Pharmacy Auditing Standards and Appeals Process

Md. Code Ins. Law § 15–1628.2 

Md. Code Ins. Law § 15–1629 

2023 H 374 (Managed Care Pharmacies)

Pharmacy Reimbursement and Claw Backs

Md. Code Ins. Law § 15–1612 

Md. Code Ins. Law § 15–1628.3 

Md. Code Ins. Law § 15-1631

Registration and Licensure

Md. Code Ins. Law § 15–1604 

Regulatory Agency and Enforcement

Md. Code Ins. Law § 15–1604 

Md. Code Ins. Law § 15–1609 

Md. Code Ins. Law § 15–1642 

Transparency and Reporting Requirements

Md. Code Ins. Law § 15–1608 

Md. Code Ins. Law § 15–1609 

Md. Code Ins. Law § 15–1623 (Reports to Purchaser)

Md. Code Ins. Law § 15–1624 (Reports to Purchaser)

Spread Pricing Restrictions

 

Utilization Management Tools

Md. Code Ins. Law § 15–1633.1 (Non-Medical Switching)

Md. Code Ins. Law § 15-1634 (Non-Medical Switching)

Md. Code Ins. Law § 15–1635 (Non-Medical Switching)

Md, Code Ins. Law § 15–1636 (Non-Medical Switching)

Other

Md. Code State Pers. and Pens. Law § 2–502.2 (Reverse Auction) 

Md. Code Ins. Law § 15-1611.2 (340B) 

Massachusetts

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

Mass. Gen. Laws ch. 175 § 22-226 

Registration and Licensure

 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

Mass. Gen. Laws ch. 1760 § 22-21 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Michigan

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Mich. Comp. Laws § 333.17757 

Mich. Comp. Laws § 550.831 

Mich. Comp. Laws § 550.927 

Fiduciary Responsibility

Mich. Comp. Laws § 550.825

Maximum Allowable Cost (MAC) Lists

Mich. Comp. Laws § 550.837 

Network Adequacy Requirement

Mich. Comp. Laws § 550.827 

Mich. Comp. Laws § 550.839

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Mich. Comp. Laws § 550.838 

Pharmacy Reimbursement and Claw Backs

Mich. Comp. Laws § 550.825

Mich. Comp. Laws § 550.839

Registration and Licensure

Mich. Comp. Laws § 550.821 

Mich. Comp. Laws § 550.910 

Regulatory Agency and Enforcement

Mich. Comp. Laws § 550.821 

Mich. Comp. Laws § 550.840 

Mich. Comp. Laws § 550.950 

Mich. Comp. Laws § 550.952 

Transparency and Reporting Requirements

Mich. Comp. Laws § 550.833 

Spread Pricing Restrictions

Mich. Comp. Laws § 550.827 

Utilization Management Tools

 

Other

Mich. Comp. Laws § 333.17757b (340B) 

Mich. Comp. Laws § 550.829 (340B) 

Mich. Comp. Laws § 550.926 (340B) 

Minnesota

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Minn. Rev. Stat. § 62W.076

Minn. Rev. Stat. § 62W.11

Minn. Rev. Stat. § 151.214 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Minn. Rev. Stat. § 62W.08 

Network Adequacy Requirement

Minn. Rev. Stat. § 62W.05 

Patient Steering Provisions

Minn. Rev. Stat. § 62W.07 

Pharmacy Auditing Standards and Appeals Process

Minn. Rev. Stat. § 62W.09 

Pharmacy Reimbursement and Claw Backs

Minn. Rev. Stat. § 62W.09 

Minn. Rev. Stat. § 62W.12 

Minn. Rev. Stat. § 62W.13 

Registration and Licensure

Minn. Rev. Stat. § 62W.03 

Regulatory Agency and Enforcement

Minn. Rev. Stat. § 62W.03 

Transparency and Reporting Requirements

Minn. Rev. Stat. § 62W.06 

Spread Pricing Restrictions

 

Utilization Management Tools

Minn. Rev. Stat. § 62W.075 (Non-Medical Switching)

Other

Minn. Rev. Stat. § 62W.07 (340B)

Mississippi

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Miss. Code Ann. § 73-21-205 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Miss. Code Ann. § 73-21-156 

Network Adequacy Requirement

Miss. Code Ann. § 73-21-161 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Miss. Code Ann. § 73-21-156 

Miss. Code Ann. § 73-21-183 

Pharmacy Reimbursement and Claw Backs

Miss. Code Ann. § 73-21-155

Registration and Licensure

Miss. Code Ann. § 73-21-157 

Regulatory Agency and 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 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

Missouri

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Mo. Rev. Stat. § 376.387 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Mo. Rev. Stat. § 376.388

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Mo. Rev. Stat. § 338.600 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

Mo. Rev. Stat. § 376.393 

Regulatory Agency and Enforcement

Mo. Rev. Stat. § 376.387 

Mo. Rev. Stat. § 376.393 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

Mo. Rev. Stat. § 376.392 (Notice to Enrollees of Formulary Change)

Other

 

Montana

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Mont. Code Ann. § 33-2-2404 

Mont. Code Ann. § 33-22-174

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Mont. Code Ann. § 33-22-171

Mont. Code Ann. § 33-22-172 

Mont. Code Ann. § 33-22-173

Network Adequacy Requirement

Mont. Code Ann. § 33-2-2409 

Mont. Code Ann. § 33-22-177

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

Mont. Code Ann. § 33-22-175 

Mont. Code Ann. § 33-22-176 

Registration and Licensure

Mont. Code Ann. § 33-2-2403 

Regulatory Agency and Enforcement

Mont. Code Ann. § 33-2-2403 

Mont. Code Ann. § 3-2-2411 

Transparency and Reporting Requirements

Mont. Code Ann. § 33-2-2406 

Mont. Code Ann. § 33-2-2407 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

Mont. Code Ann. § 33-2-2410 (340B) 

2023 H 379 (340B)

Nebraska

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Neb. Rev. Stat. § 44-4606 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Neb. Rev. Stat. § 44-4608 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Neb. Rev. Stat. § 44-4607 

Pharmacy Reimbursement and Claw Backs

Neb. Rev. Stat. § 44-4607 

Registration and Licensure

Neb. Rev. Stat. § 44-4602 

Neb. Rev. Stat. § 44-4605 

Regulatory Agency and Enforcement

Neb. Rev. Stat. § 44-4605 

Neb. Rev. Stat. § 44-4611 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

Neb. Rev. Stat. § 44-7,112 (Step-Therapy)

Neb. Rev. Stat. § 44-7,113 (Step-Therapy)

Neb. Rev. Stat. § 44-7,114 (Step-Therapy)

Neb. Rev. Stat. § 44-7,115 (Step-Therapy)

Neb. Rev. Stat. § 44-7,117 (Step-Therapy)

Other

Neb. Rev. Stat. § 44-4609 (340B) 

Neb. Rev. Stat. § 44-4606 (Copay Accumulator)

Nevada

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Nev. Rev. Stat. § 638A.179(1)a 

Fiduciary Responsibility

Nev. Rev. Stat. § 638A.178 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

Nev. Rev. Stat. § 638A.179(1)d 

Registration and Licensure

 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

Nev. Rev. Stat. § 439B.630

Nev. Rev. Stat. § 439B.645

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

2023 A 434 (340B)

New Hampshire

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

N.H. Rev. Stat. Ann. § 402-N:3 

Network Adequacy Requirement

 

Patient Steering Provisions

N.H. Rev. Stat. Ann. § 402-N:4-a 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

N.H. Rev. Stat. Ann. § 402-N:4 

Registration and Licensure

N.H. Rev. Stat. Ann. § 402-N:2 

Regulatory Agency and Enforcement

N.H. Rev. Stat. Ann. § 402-N:2 

N.H. Rev. Stat. Ann. § 402-N:5 

N.H. Rev. Stat. Ann. § 402-N:7 

Transparency and Reporting Requirements

N.H. Rev. Stat. Ann. § 402-N:6 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

New Mexico

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

N.M. Stat. Ann. § 59A-61-5E(3)(c) 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

N.M. Stat. Ann. § 59-61-4 

Network Adequacy Requirement

N.M. Stat. Ann. § 59A-61-5(H) 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

N.M. Stat. Ann § 61-11-18.2

Pharmacy Reimbursement and Claw Backs

N.M. Stat. Ann. § 59A-61-7

Registration and Licensure

N.M. Stat. Ann. § 59A-61-3 

Regulatory Agency and Enforcement

N.M. Stat. Ann. § 59A-61-3 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

N.M. Stat. Ann. § 59A-22B-4 (Prior Authorization)

N.M. Stat. Ann. § 59A-22B-5 (Prior Authorization)

N.M. Stat. Ann. § 59A-22-53.1 (Step-Therapy)

N.M. Stat. Ann. § 59-A-22-53.3 (Copay Accumulator)

Other

 

New York

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

N.Y. Pub. Health Law § 280-A(5a)

(2023 A 2200) N.Y. Pub. Health Law § 3217-A(g) and N.Y. Ins. Law § 4324(g)

Fiduciary Responsibility

N.Y. Pub. Health Law § 280-A(2)

Maximum Allowable Cost (MAC) Lists

N.Y. Pub. Health Law § 280-A(4) 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

N.Y. Pub. Health Law § 280-C

Pharmacy Reimbursement and Claw Backs

N.Y. Pub. Health Law § 280-C(3)

Registration and Licensure

N.Y. Ins. Law § 2903 

Regulatory Agency and Enforcement

N.Y. Pub. Health L § 280-A(2g)

N.Y. Ins. Law § 2902 

N.Y. Ins. Law § 2905 

N.Y. Ins. Law § 2907 

N.Y. Ins. Law § 2908

N.Y. Ins. Law § 2909

N.Y. Ins. Law § 2910

N.Y. Ins. Law § 2911 

Transparency and Reporting Requirements

N.Y. Ins. Law § 2904 

Spread Pricing Restrictions

N.Y. Pub. Health L § 4406-C(10a)

Utilization Management Tools

N.Y. Ins. Law § 3216(37) (Copay Accumulator)

N.Y. Ins. Law § 3242 (Non-Medical Switching)

N.Y. Ins. Law § 4329 (Non-Medical Switching)

Other

 

North Carolina

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

N.C. Gen Stat. § 58-56A-3 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

N.C. Gen. Stat. § 58-56A-5 

Network Adequacy Requirement

N.C. Gen. Stat. § 58-51-37 

N.C. Gen. Stat. § 58-56A-15 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

N.C. Gen. Stat. § 90-85.50 

Pharmacy Reimbursement and Claw Backs

N.C. Gen. Stat. § 58-56A-4 

N.C. Gen. Stat. § 90-85.50

Registration and Licensure

N.C. Gen. Stat. § 58-56A-2 

Regulatory Agency and Enforcement

N.C. Gen. Stat. § 58-56A-25 

N.C. Gen. Stat. § 58-56A-30 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

N.C. Gen. Stat. § 58-3-221 (Process for Formulary Exceptions)

Other

N.C. Gen Stat. § 58-56A-3(c1) (Copay Accumulator)

N.C. Gen. Stat. § 58-56A-50 (340B) 

North Dakota

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

N.D. Cent. Code § 19-02.1-16.1(7) 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

N.D. Cent. Code § 19-02.1-14.2 

Network Adequacy Requirement

N.D. Cent. Code § 19-02.1-16.2 

Patient Steering Provisions

N.D. Cent. Code § 19-02.1-16.2 

Pharmacy Auditing Standards and Appeals Process

N.D. Cent. Code § 19-03.6-02

Pharmacy Reimbursement and Claw Backs

N.D. Cent. Code § 19-03.6-03 

Registration and Licensure

N.D. Cent. Code § 26.1-27.1-02 

Regulatory Agency and Enforcement

N.D. Cent. Code § 26.1-27.1-07 

N.D. Cent. Code § 26.1-36.10-06

N.D. Cent. Code § 26.1-36.10-07

N.D. Cent. Code § 26.1-36.10-08 

Transparency and Reporting Requirements

N.D. Cent. Code § 26.1-36.10 

Spread Pricing Restrictions

 

Utilization Management Tools

N.D. Cent. Code § 19-02.1-16.3 (Step-Therapy) 

Other

N.D. Cent. Code § 19-02.1-16.5 (340B) 

(2023 S 2378) N.D. Cent. Code § 19-02.1-16.6 (White-Bagging)

Ohio

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Ohio Rev. Code § 3959.20 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Ohio Rev. Code § 3959.111

Ohio Rev. Code § 5167.245 (Medicaid) 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Ohio Rev. Code § 3901.811

Ohio Rev. Code § 3901.812

Ohio Rev. Code § 3901.813

Ohio Rev. Code § 3901.814

Pharmacy Reimbursement and Claw Backs

Ohio Rev. Code § 3959.20 

Registration and Licensure

Ohio Rev. Code § 3959.05 

Regulatory Agency and Enforcement

Ohio Rev. Code § 3959.04

Ohio Rev. Code § 3959.12

Ohio Rev. Code § 5167.244 (Medicaid) 

Transparency and Reporting Requirements

Ohio Rev. Code § 5167.243 (Medicaid) 

Ohio Rev. Code § 5167.122 (Medicaid)

Spread Pricing Restrictions

2019 HB 166 (Medicaid Regulatory Change, Not Legislation)

Utilization Management Tools

Ohio Rev. Code § 3923.014 (Prior Authorization)

Ohio Rev. Code § 3901.831 (Step-Therapy)

Ohio Rev. Code § 3901.832 (Step-Therapy)

Other

Ohio Rev. Code § 5167.24 (Reverse Auction) 

Ohio Rev. Code § 5167.24(4) (White-Bagging) 

Oklahoma

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Okla. Stat. 36 § 6962(C)(1) 

Okla. Stat. 36 § 6963(C) 

Okla. Stat. 59 § 359 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Okla. Stat. 59 §360 

Network Adequacy Requirement

Okla. Stat. 36 § 6961

Okla. Stat. 36 § 6962(B)(4)(5)

Okla. Stat. 36 § 6963(D)(E) 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Okla. Stat. 59 § 356.1

Okla. Stat. 59 § 356.2

Okla. Stat. 59 § 356.3

Pharmacy Reimbursement and Claw Backs

Okla. Stat. 36 § 6962(B)(2)(3)(6)(7)(9)

Registration and Licensure

Okla. Stat. 59 §358 

Regulatory Agency and Enforcement

Okla. Stat. § 6965 

Okla. Stat. § 6966

Okla. Stat. 59 §358 

Transparency and Reporting Requirements

Okla. Stat. 36 § 6962(D)

Spread Pricing Restrictions

Okla. Stat. 36 § 6962(B)(8) 

Utilization Management Tools

Okla. Stat. 63 § 7310 (Step-Therapy)

Okla. Stat. 63 § 7330 (Step-Therapy)

Other

Okla. Stat. 36 § 1250.5(18) Copay Accumulator)

Oregon

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Or. Rev. Stat. § 735.536 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Or. Rev. Stat. § 735.534

Network Adequacy Requirement

 

Patient Steering Provisions

Or. Rev. Stat. § 735.536

Pharmacy Auditing Standards and Appeals Process

Or. Rev. Stat. § 735.542

Or. Rev. Stat. § 735.544

Or. Rev. Stat. § 735.546

Or. Rev. Stat. § 735.548

Or. Rev. Stat. § 735.550

Or. Rev. Stat. § 735.552

Pharmacy Reimbursement and Claw Backs

(2023 OR H 2725) Or. Rev. Stat. § 735.534

Or. Rev. Stat. § 735.542

Registration and Licensure

Or. Rev. Stat. § 735.532 

Regulatory Agency and Enforcement

Or. Rev. Stat. § 735.532 

Or. Rev. Stat. § 735.533

Transparency and Reporting Requirements

Or. Rev. Stat. § 646A.689

Spread Pricing Restrictions

 

Utilization Management Tools

Or. Rev. Stat. § 743B.420 (Prior Authorization) 

Or. Rev. Stat. § 743B.420 (Prior Authorization) 

Or. Rev. Stat. § 743B.420 (Prior Authorization) 

Or. Rev. Stat. § 743B.420 (Prior Authorization) 

Or. Rev. Stat. § 743B.420 (Step-Therapy) 

Or. Rev. Stat. § 414.772 (Step-Therapy) 

Other

Or. Rev. Stat. § 735.534 (340B)

Or. Rev. Stat. § 735.536 (White-Bagging)

Pennsylvania

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

2020 Act 67 § 3 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

2016 Act 169 § 701-705 

Network Adequacy Requirement

Pa. P.L. 1208 No. 120 § 449 (h1)(h2) 

Patient Steering Provisions

Pa. P.L. 1208 No. 120 § 449 (g) 

Pharmacy Auditing Standards and Appeals Process

2016 Act 169 § 301

Pharmacy Reimbursement and Claw Backs

2016 Act 169 § 301 (b)(5)

Pa. P.L. 1208 No. 120 § 449 (f1)(f2) 

Registration and Licensure

2016 Act 169 § 501 

Regulatory Agency and Enforcement

2016 Act 169 § 9 

Transparency and Reporting Requirements

Pa. P.L. 1208 No. 120 § 449 (j) 

Spread Pricing Restrictions

Pa. P.L. 1208 No. 120 § 449 (h3) 

Utilization Management Tools

 

Other

 

Rhode Island

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

27 R.I. Gen. Laws § 20.8-4

27 R.I. Gen. Laws § 20.8-2

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

27 R.I. Gen. Laws § 29.1-3 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

5 R.I. Gen. Laws § 19.1-35 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

27 R.I. Gen. Laws § 20.7-12 

Regulatory Agency and Enforcement

27 R.I. Gen. Laws § 20.7-12 

27 R.I. Gen. Laws § 29.1-8

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

South Carolina

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

S.C. Code Ann. § 38-71-2220 

Fiduciary Responsibility

(2023 S 520) S.C. Code Ann. § 38-71-2235

Maximum Allowable Cost (MAC) Lists

S.C. Code Ann. § 38-71-2240 

Network Adequacy Requirement

S.C. Code Ann. § 38-71-147

S.C. Code Ann. § 38-71-2230(E) 

(2023 S 520) S.C. Code Ann. § 38-71-2245

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

(2023 S 520) S.C. Code Ann. § 38-71-2230(A)(B)(C) 

(2023 S 520) S.C. Code Ann. § 38-71-1810 

(2023 S 520) S.C. Code Ann. § 38-71-1820

(2023 S 520) S.C. Code Ann. § 38-71-1820

Registration and Licensure

(2023 S 520) S.C. Code Ann. § 38-71-2210 

Regulatory Agency and Enforcement

(2023 S 520) S.C. Code Ann. § 38-71-2210 

(2023 S 520) S.C. Code Ann. § 38-71-2250 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

 

South Dakota

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

(2023 H 1135) S.D. Code Ann. § 58-29E-8.1 

58-33-135 

Fiduciary Responsibility

(2023 H 1135) S.D. Code Ann. § 58-29E-3 

Maximum Allowable Cost (MAC) Lists

(2023 H 1135) S.D. Code Ann. § 58-29E-17

(2023 H 1135) S.D. Code Ann. § 58-29E-18

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

S.D. Code Ann. § 58-29F-3

S.D. Code Ann. § 58-29F-4 

S.D. Code Ann. § 58-29F-5 

S.D. Code Ann. § 58-29F-6 

S.D. Code Ann. § 58-29F-8 

S.D. Code Ann. § 58-29F-9

Pharmacy Reimbursement and Claw Backs

(2023 H 1135) S.D. Code Ann. § 58-29E-12

(2023 H 1135) S.D. Code Ann. § 58-29E-13

(2023 H 1135) S.D. Code Ann. § 58-29E-14

(2023 H 1135) S.D. Code Ann. § 58-29E-16

(2023 H 1135) S.D. Code Ann. § 58-29E-19

S.D. Code Ann. § 58-29F-6 

Registration and Licensure

(2023 H 1135) S.D. Code Ann. § 58-29E-2 

Regulatory Agency and Enforcement

S.D. Code Ann. § 58-29D-31

S.D. Code Ann. § 58-29E-9

(2023 H 1135) S.D. Code Ann. § 58-29E-10

(2023 H 1135) S.D. Code Ann. § 58-29E-21

Transparency and Reporting Requirements

(2023 H 1135) S.D. Code Ann. § 58-29E-4 (Reports to Payer)

(2023 H 1135) S.D. Code Ann. § 58-29E-6

Spread Pricing Restrictions

 

Utilization Management Tools

S.D. Code Ann. § 58-17H-53 (Step-Therapy)

S.D. Code Ann. § 58-17H-54 (Step-Therapy)

S.D. Code Ann. § 58-17H-55 (Step-Therapy)

S.D. Code Ann. § 58-17H-56 (Step-Therapy)

Other

S.D. Code Ann. § 58-29E-15 (340B) 

Tennessee

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Tenn. Code Ann. § 56-7-3114

Tenn. Code Ann. § 56-7-3203 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Tenn. Code Ann. § 56-7-3106 

Tenn. Code Ann. § 56-7-3107 

Tenn. Code Ann. § 56-7-3108 

Tenn. Code Ann. § 56-7-3111

Network Adequacy Requirement

 

Patient Steering Provisions

Tenn. Code Ann. § 56-7-3121

Pharmacy Auditing Standards and Appeals Process

Tenn. Code Ann. § 56-7-3103 

Tenn. Code Ann. § 56-7-3118 

Pharmacy Reimbursement and Claw Backs

Tenn. Code Ann. § 56-7-3103 

Tenn. Code Ann. § 56-7-3104 

Tenn. Code Ann. § 56-7-3112

Tenn. Code Ann. § 56-7-3115

Tenn. Code Ann. § 56-7-3206 

Registration and Licensure

Tenn. Code Ann. § 56-7-3113

Regulatory Agency and Enforcement

Tenn. Code Ann. § 56-7-3101 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

Tenn. Code Ann. § 56-7-3119 (340B) 

Tenn. Code Ann. § 56-7-3120 (340B) 

Tenn. Code Ann. § 56-7-3205 (Copay Accumulator)

Texas

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Tex. Ins. Code § 1369.351

Tex. Ins. Code § 1369.352 

Tex. Ins. Code § 1369.353 

Tex. Ins. Code § 1369.354 

Tex. Ins. Code § 1369.355 

Tex. Ins. Code § 1369.356 

Tex. Ins. Code § 1369.357 

Tex. Ins. Code § 1369.358 

Network Adequacy Requirement

 

Patient Steering Provisions

Tex. Ins. Code § 1369.554

Tex. Ins. Code § 1369.555

Pharmacy Auditing Standards and Appeals Process

Tex. Ins. Code § 1369.254

Tex. Ins. Code § 1369.255

Tex. Ins. Code § 1369.256

Tex. Ins. Code § 1369.257

Tex. Ins. Code § 1369.258

Tex. Ins. Code § 1369.2581

Tex. Ins. Code § 1369.254

Tex. Ins. Code § 1369.263

Tex. Ins. Code § 1369.264

Pharmacy Reimbursement and Claw Backs

Tex. Ins. Code § 1369.259

Tex. Ins. Code § 1369.266

Tex. Ins. Code § 1369.401

Tex. Ins. Code § 1369.402

Tex. Ins. Code § 1369.603

Tex. Ins. Code § 1369.604

Registration and Licensure

 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

Tex. Ins. Code § 1369.502 

Spread Pricing Restrictions

 

Utilization Management Tools

Tex. Ins. Code § 1369.304 (Prior Authorization Standard Form)

Tex. Ins. Code § 1369.0541 (Non-Medical Switching) 

Tex. Ins. Code § 1369.0545 (Step-Therapy) 

Tex. Ins. Code § 1369.0546 (Step-Therapy)

Tex. Ins. Code § 1369.0547 (Step-Therapy for Serious Mental Illness Drugs)

(2023 H 1647) Tex. Ins. Code § 1369.764 (White-Bagging)

(2023 H 4990) Tex. Gov. Code § 2177 State Pharmaceutical Initiative

Other

(2023 H 999) Tex. Gov. Code § 1369.0542 (Copay Accumulator)

(2023 H 1647) Tex. Ins. Code § 1369.764 (White-Bagging)

(2023 H 4990) Tex. Gov. Code § 2177 State Pharmaceutical Initiative

Utah

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Utah Code § 31A-46-302 4(a) 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Utah Code § 31A-46-303 

Network Adequacy Requirement

Utah Code § 31A-46-306 

Utah Code § 31A-46-308 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

Utah Code § 31A-46-304

Utah Code § 31A-46-305

Registration and Licensure

Utah Code § 31A-46-201 

Regulatory Agency and Enforcement

Utah Code § 31A-46-202 

Utah Code § 31A-2-308 

Transparency and Reporting Requirements

Utah code § 31A-46-301

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

Utah Code § 31A-46-305 (340B)

Utah Code § 31A-46-308 (White-Bagging)

Utah Code § 31A-46-310 (340B) 

Vermont

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

18 V.S.A. § 9472 (c) 

18 V.S.A. § 9473 (b)(c) 

18 V.S.A. § 9472 (f) 

Fiduciary Responsibility

18 V.S.A. § 9472 (a) 

Maximum Allowable Cost (MAC) Lists

18 V.S.A. § 9473 (f) 

Network Adequacy Requirement

8 V.S.A. § 4089j (b)(d) 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

18 V.S.A. § 3802 

Pharmacy Reimbursement and Claw Backs

8 V.S.A. § 4089j (b) 

18 V.S.A. § 9473 (a)(i) 

18 V.S.A. § 3802 (11)(12) 

Registration and Licensure

18 V.S.A. § 9421 (a) 

Regulatory Agency and Enforcement

18 V.S.A. § 9421 (e)(f) 

18 V.S.A. § 9474 

Transparency and Reporting Requirements

18 V.S.A. § 9472 (d) 

Spread Pricing Restrictions

 

Utilization Management Tools

18 V.S.A. § 9472 (e) (Non-Medical Switching)

18 V.S.A. § 9473 (k) (Non-Medical Switching)

Other

(2023 H 222) 8 V.S.A. § 4089i (e)

8 V.S.A. § 4089j (3) (Brown-Bagging) 

8 V.S.A. § 4089j (3) (White-Bagging) 

18 V.S.A. § 9472 (2) (Copay accumulator)

18 V.S.A. 9473 (g)(h) (340B) 

Virginia

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Va. Code Ann. § 38.2-3407.15:4 (B)(C)(D) 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Va. Code Ann. § 38.2-3407.15:3 

Network Adequacy Requirement

Va. Code Ann. § 38.2-3407.7 

Va. Code Ann. § 38.2-3467(C)

Patient Steering Provisions

Va. Code Ann. § 38.2-3467(A6)(B) 

Va. Code Ann. § 38.2-4312.1 

Pharmacy Auditing Standards and Appeals Process

Va. Code Ann. § 38.2-3407.15:1

Pharmacy Reimbursement and Claw Backs

Va. Code Ann. § 38.2-3467(A2)(A3) 

Registration and Licensure

Va. Code Ann. § 38.2-3466 

Regulatory Agency and Enforcement

Va. Code Ann. § 38.2-3466 

Va. Code Ann. § 38.2-3469 

Transparency and Reporting Requirements

Va. Code Ann. § 38.2-3407.15:6 

Va. Code Ann. § 38.2-3468 

Spread Pricing Restrictions

Va. Code Ann. § 38.2-3467(D) 

Utilization Management Tools

Va. Code Ann. 38.2-3407.9:05 (Step-Therapy)

Va. Code Ann. § 38.2-3407.15:2 (Prior Authorization) 

Other

Va. Code Ann. § 38.2-3407.7 (White-Bagging)

Va. Code Ann. § 38.2-3407.20 (Copay Accumulator)

Va. Code Ann. § 38.2-3467 (5) (340B) 

Washington

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

Wash. Rev. Code § 48.200.280 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Wash. Rev. Code § 48.200.220

Wash. Rev. Code § 48.200.230 

Wash. Rev. Code § 48.200.240 

Wash. Rev. Code § 48.200.250

Wash. Rev. Code § 48.200.260

Pharmacy Reimbursement and Claw Backs

Wash. Rev. Code § 48.200.260

Registration and Licensure

Wash. Rev. Code § 48.200.030 

Regulatory Agency and Enforcement

Wash. Rev. Code § 48.200.900 

Wash. Rev. Code § 48.200.050 

Wash. Rev. Code § 48.200.290 

Transparency and Reporting Requirements

Wash. Rev. Code § 43.71C.030 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

Wash. Rev. Code § 48.43.420 (Utilization Management Policies)

Wash. Rev. Code § 48.43.435 (Copay Accumulator) 

Wash. Rev. Code § 284-43-5080 (Utilization Management Policies)

Wash. Rev. Code § 284-43-5100 (Formulary Changes)

Wash. Rev. Code § 284-43-5170 (Drug Benefit Disclosures)

West Virginia

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

W. Va. Code § 33-51-9(a)(b) 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

W. Va. Code § 33-51-8(d) 

Patient Steering Provisions

W. Va. Code § 33-51-11 

Pharmacy Auditing Standards and Appeals Process

W. Va. Code § 33-51-4 

W. Va. Code § 33-51-5 

W. Va. Code § 33-51-6

Pharmacy Reimbursement and Claw Backs

W. Va. Code § 33-51-4 

W. Va. Code § 33-51-9 (e)(f)(h)(2)

Registration and Licensure

W. Va. Code § 33-51-7 

W. Va. Code § 33-51-8(a)(b)(c) 

Regulatory Agency and Enforcement

W. Va. Code § 33-51-8(e) 

W. Va. Code § 33-51-10 

Transparency and Reporting Requirements

W. Va. Code § 33-51-12 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

W. Va. Code § 33-15-4(t) (Copay Accumulator)

W. Va. Code § 33-51-9 (c)(d) (340B) 

W. Va. Code § 33-51-9 (e)(f)(h)(2) (Rebate Pass-Through)

Wisconsin

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Wis. Stat. § 632.861(2)(3) 

Fiduciary Responsibility

Wis. Stat. § 633.14 (2)(c) 

Maximum Allowable Cost (MAC) Lists

Wis. Stat. § 632.865 (2)(a) 

Network Adequacy Requirement

Wis. Stat. § 632.865 (4)

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Wis. Stat. § 632.865 (6)

Pharmacy Reimbursement and Claw Backs

Wis. Stat. § 632.865 (4)

Registration and Licensure

Wis. Stat. § 632.865 (3)

Wis. Stat. § 633.14 (2)

Regulatory Agency and Enforcement

Wis. Stat. § 633.14 (3)

Wis. Stat. § 633.15

Wis. Stat. § 633.17 

Transparency and Reporting Requirements

Wis. Stat. § 632.865(7) 

Spread Pricing Restrictions

 

Utilization Management Tools

Wis. Stat. § 632.853 (Prio Authorization)

Wis. Stat. § 632.866 (Step-Therapy) 

Other

 

Wyoming

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

Wyo. Stat. Ann. § 56-52-104(j) 

Fiduciary Responsibility

 

Maximum Allowable Cost (MAC) Lists

(2023 S 151) Wyo. Stat. Ann. § 56-52-104 

Network Adequacy Requirement

(2023 S 151) Wyo. Stat. Ann. § 26-52-105

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

Wyo. Stat. Ann. § 26-52-103

Pharmacy Reimbursement and Claw Backs

(2023 S 151) Wyo. Stat. Ann. § 26-52-105

Registration and Licensure

Wyo. Stat. Ann. § 56-52-101 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

(2023 S 151) Wyo. Stat. Ann. § 26-52-105

Utilization Management Tools

 

Other

 

District of Columbia

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

D.C. Code Ann. § 48–832.01

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

 

Regulatory Agency and Enforcement

 

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

 

Other

2023 D.C. B 141 (Copay Accumulator)

Puerto Rico

Provision

Statute

Cost Disclosure and Gag Clause Restrictions

 

Fiduciary Responsibility

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

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy Requirement

 

Patient Steering Provisions

 

Pharmacy Auditing Standards and Appeals Process

 

Pharmacy Reimbursement and Claw Backs

 

Registration and Licensure

 

Regulatory Agency and Enforcement

Laws of P.R. Ann. 24 § 7004

Transparency and Reporting Requirements

 

Spread Pricing Restrictions

 

Utilization Management Tools

Laws of P.R. Ann. 26 § 3-9046 (Formularies)

Laws of P.R. Ann. 26 § 3-9043 (Prior Authorization)

Laws of P.R. Ann. 26 § 3-9047 (Step-Therapy)

Other

Laws of P.R. 26 § 4.070 (Copay Accumulator)

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