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Related Topic: Health

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Provision

Statute

Cost Disclosure/Gag Clause

Ala. Code §27-45A-10 (2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

Ala. Code §27-45-3 (1988)

Patient Steering

Ala. Code §27-45A-8 (2021)

Pharmacy Auditing Standards/Appeals Process

Ala. Code §34-23-184 (2018)

Pharmacy Reimbursement/Claw Backs

Ala. Code §27-45A-10 (2021)

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

 

Provision

Statute

Cost-Disclosure/Gag-Clause 

Alaska Stat. §08.80.297  

Fiduciary 

 

Maximum Allowable Cost (MAC) Lists 

Alaska Stat. §145.400 (Medicaid) (AAC)  

Alaska Stat. §21.27.945 

Alaska Stat. §21.27.950 

Network Adequacy 

Alaska Stat. §21.27.945 

Alaska Stat. §21.27.950  

Patient Steering 

 

Pharmacy Auditing Standards/Appeals Process 

Alaska Stat. §21.27.910 

Alaska Stat. §21.27.930 

Alaska Stat. §21.27.950 

Pharmacy Reimbursement/Claw Backs 

 

Alaska Stat. §21.27.915 

Alaska Stat. §21.27.920 

Registration/Licensure 

Alaska Stat. §21.27.901 

Regulatory Agency/Enforcement 

Alaska Stat. §08.80.030 

Reporting/Transparency Requirements 

Alaska Stat. §21.27.945 

Spread Pricing 

 

Utilization Management Tools 

 

Other 

 

Provision

Statute

Cost Disclosure/Gag Clause

Ariz. Rev. Stat. Ann. §44-1752

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Ariz. Rev. Stat. Ann. §20-3331

Network Adequacy

Ariz. Rev. Stat. Ann. §44-1754

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Ariz. Rev. Stat. Ann. §20-3332

Pharmacy Auditing Standards

Appeals Process

Ariz. Rev. Stat. Ann. §20-3322

Ariz. Rev. Stat. Ann. §20-3323

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

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

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

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

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Ark. Stat. Ann. §23-92-507 (2019)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Ark. Stat. Ann. §17-92-507 (2019)

Network Adequacy

Ark. Stat. Ann. §23-92-505 (2021)

Patient Steering

 

Pharmacy Auditing Standards/Appeals Process

Ark. Stat. Ann. §17-92-1201 (2021)

Pharmacy Reimbursement/Claw Backs

Ark. Stat. Ann. §17-92-507 (2019)

Ark. Stat. Ann. §23-92-506 (2021)

Registration/Licensure

Ark. Stat. Ann. §23-92-504 (2018)

Regulatory Agency/Enforcement

Ark. Stat. Ann. §23-92-508 (2018)

Ark. Stat. Ann. §23-92-509 (2021)

Reporting/Transparency Requirements

Ark. Stat. Ann. §23-92-505 (2021)

Spread Pricing

Ark. Stat. Ann. §23-92-505 (2021)

Utilization Management Tools

Ark. Stat. Ann. §23-99-1114 (2021) (Step-Therapy)

Ark. Stat. Ann. §23-79-2101 (2021) (Step-Therapy)

Other

Ark. Stat. Ann. §23-92-601—23-92-606 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Cal. B.P.C. Code §4441 (2018)

Fiduciary

Cal. H.S.C. Code §1385.004 (2018)

Maximum Allowable Cost (MAC) Lists

Cal. B.P.C. Code §4440 (2015)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Cal. B.P.C. Code §4438 (2012)

Pharmacy Auditing Standards

Appeals Process

Cal. B.P.C. Code §4433 - 4438 (2012)

Registration/Licensure

Cal. H.S.C. Code §1385.0041385.005 (2018)

Regulatory Agency/Enforcement

Cal. B.P.C. Code §4439 (2012)

Cal. H.S.C. Code §1385.002 (2018)

Cal. H.S.C. Code §1385.006 (2018)

Reporting/Transparency Requirements

Cal. B.P.C. Code §4441 (2018)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Colo. Rev. Stat. §10-16-122.7 (2018)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Colo. Rev. Stat. §25-37-103.5 (2015)

Network Adequacy

Colo. Rev. Stat. §24-51-1202 (2010)

Colo. Rev. Stat. §10-16-122 (2021)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Colo. Rev. Stat. §10-16-122.3 (2021)

Pharmacy Auditing Standards

Appeals Process

Colo. Rev. Stat. §10-16-122.5 (2021)

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

Colo. Rev. Stat. §10-16-124.5 (2019) (Prior Authorization)

Other

Colo. Rev. Stat. §24-50-1204 (2021) (Reverse Auction)

Provision

Statute

Cost Disclosure/Gag Clause

Conn. Gen. Stat. §38a-477cc (2018)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement/

Clawbacks

Conn. Gen. Stat. §38a-477cc (2018)

Pharmacy Auditing Standards

Appeals Process

Conn. Gen. Stat. §38a-479iii (2008)

Registration/Licensure

Conn. Gen. Stat. §38a-479bbb (2008)

Regulatory Agency/Enforcement

Conn. Gen. Stat. §38a-479ccc-hhh (2008)

Reporting/Transparency Requirements

Conn. Gen. Stat. §.38a-479ppp (2020)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Fla. Stat. §465.0244 (2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Fla. Stat. §627.64741 (2021)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

Fla. Stat. §465.1885 (2021)

Registration/Licensure

Fla. Stat. §624.490 (2021)

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

Fla. Stat. §627.42392 (2021) (Prior Authorization)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Ga. Code Ann. §33-64-11 (2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Ga. Code Ann. §33-64-9 (2016)

Network Adequacy

Ga. Code Ann. §33-64-10 (2021)

Patient Steering

Ga. Code Ann. §26-4-119 (2021)

Ga. Code Ann. § 33-64-11 (2021)

Ga. Code Ann. §33-64-12 (2021)

Pharmacy Reimbursement

Clawbacks

Ga. Code Ann. §33-64-9.1 (2021)

Ga. Code Ann. §33-64-11 (2021)

Pharmacy Auditing Standards

Appeals Process

Ga. Code Ann. §26-4-118 (2021)

Ga. Code Ann. §33-64-5 (2011)

Registration/Licensure

Ga. Code Ann. §33-64-2 (2021)

Regulatory Agency/Enforcement

Ga. Code Ann. §33-64-7 (2021)

Reporting/Transparency Requirements

Ga. Code Ann. §33-64-10 (2021)

Spread Pricing

Ga. Code Ann. §33-64-10 (2021)

Utilization Management Tools

Ga. Code. Ann. §33-64-8 (2012) (Prior Authorization)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Hawaii Rev. Stat. §328-106 (2015)

Network Adequacy

Hawaii Rev. Stat. §431R-2 (2013)

Hawaii Rev. Stat. §431R-3 (2013)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

Hawaii Rev. Stat. §431S-3 (2021)

 

Regulatory Agency/Enforcement

Hawaii Rev. Stat. §431R-5 (2016)

Hawaii Rev. Stat. §431R-4 (2013)

Hawaii Rev. Stat. §431R-7 (2013)

Reporting/Transparency Requirements

Hawaii Rev. Stat. §431R-4 (2013)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Idaho Code §41-349 (2020)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Idaho Code §41-349 (2020)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

Idaho Code §41-349 (2020)

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Ill. Rev. Stat. ch. 215 §5/513b1

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Ill. Rev. Stat. ch. 215 §5/513b1

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Ill. Rev. Stat. ch. 215 §5/513b1

Pharmacy Auditing Standards

Appeals Process

Ill. Rev. Stat. ch. 215 §5/513b1

Registration/Licensure

Ill. Rev. Stat. ch. 215 §5/513b2

Regulatory Agency/Enforcement

Ill. Rev. Stat. ch. 215 §5/513b3

Ill. Rev. Stat. ch. 215 §5/513b4

Ill. Rev. Stat. ch. 215 §5/513b5

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Ind. Code §10-8-20 (2020)

Fiduciary

Ind. Code §27-1-25-6 (2021)

Maximum Allowable Cost (MAC) Lists

Ind. Code §27-1-24.5-23 (2021)

Network Adequacy

Ind. Code §27-1-24.5-19 (2021)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Ind. Code §27-1-24.5-19 (2021)

Ind. Code §27-1-24.5-27.5 (2021)

Pharmacy Auditing Standards

Appeals Process

Ind. Code §27-1-24.5-22 (2021)

Registration/Licensure

Ind. Code §27-1-24.5-18 (2020)

Regulatory Agency/Enforcement

Ind. Code §27-1-24.5-20 (2020)

Reporting/Transparency Requirements

Ind. Code §27-1-24.5-21 (2020)

Ind. Code §27-1-24.5-22.5 (2020)

Spread Pricing

 

Utilization Management Tools

 

Other

Ind. Code §27-1-24.5-19.5 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Iowa Code §510B.10 (2018)

Fiduciary

Iowa Code §510B.4 (2008)

Maximum Allowable Cost (MAC) Lists

Iowa Code §510B.8 (2020)

Network Adequacy

Iowa Code §510B.7 (2008)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

Iowa Code §510B.8 (2020)

 

Registration/Licensure

Iowa Code §510B.2 (2008)

Regulatory Agency/Enforcement

Iowa Code §510C.2 (2020)

Iowa Code §510B.3 (2015)

Reporting/Transparency Requirements

Iowa Code §510C.2 (2020)

Spread Pricing

 

Utilization Management Tools

Iowa Code §510B.9 (2014)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Kan. Stat. Ann. §40-3831 (2018)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Kan. Stat. Ann. §40-3830 (2016)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Kan. Stat. Ann. §40-3830 (2016)

Pharmacy Auditing Standards

Appeals Process

Kan. Stat. Ann. §40-3830 (2016)

Kan. Stat. Ann. §65-16,123 (2011)

Kan. Stat. Ann. §65-16,124 (2011)

Registration/Licensure

Kan. Stat. Ann. §40-3823 (2006)

Kan. Stat. Ann §40-3824 (2006)

Regulatory Agency/Enforcement

Kan. Stat. Ann. §40-3830 (2016) 40-3825 (2006)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Ky. Rev. Stat. §304.17A-164 (2022)

Fiduciary

Ky. Rev. Stat. §205.5512 4(c)(1) (2020) (Medicaid)

Maximum Allowable Cost (MAC) Lists

Ky. Rev. Stat. §304.17A-162 (2016)

Network Adequacy

Ky. Rev. Stat. §205.5514 4(d) (2020) (Medicaid)

Patient Steering

Ky. Rev. Stat. §205.5512 4(c)(4biii, iv, v) (2020) (Medicaid)

Pharmacy Reimbursement

Clawbacks

Ky. Rev. Stat. §205.5512 4(c)(4bi, ii) (2020)

(Medicaid)

Pharmacy Auditing Standards

Appeals Process

Ky. Rev. Stat. §304.17A-741 (2012)

Ky. Rev. Stat. §304.17A-743 (2009)

Registration/Licensure

Ky. Rev. Stat. §304.9-053 (2016).

Regulatory Agency/Enforcement

Ky. Rev. Stat. §304.9-054 (2016)

Ky. Rev. Stat. §205.5518 (3) (2020) (Medicaid)

Ky. Rev. Stat. §304.9-440 (2021)

Reporting/Transparency Requirements

Ky. Rev. Stat. §205.647 (2020) (Medicaid)

Spread Pricing

Ky. Rev. Stat. §205.5512 4(c)(3a)(4a) (2020) (Medicaid)

Utilization Management Tools

Ky. Rev. Stat. §304.17A-163 (2012) (Step-Therapy)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

La. Rev. Stat. Ann. §22:1657 (West 2020)

La. Rev. Stat. Ann. §37:1219 (West 2018)  

Fiduciary

La. Rev. Stat. Ann. §40:2870 (West 2020)  

Maximum Allowable Cost (MAC) Lists

La. Rev. Stat. Ann. §40:2870 (West 2020) 

Network Adequacy

La. Rev. Stat. Ann. §39:1648 (West 2021) (Medicaid)

La. Rev. Stat. Ann. §40:2870 (West 2020)

Patient Steering

La. Rev. Stat. Ann. §40:2870 (West 2020)

Pharmacy Reimbursement

Clawbacks

La. Rev. Stat. Ann. §22:1860.3 (West 2018)

La. Rev. Stat. Ann. §40:2870 (West 2020)

Pharmacy Auditing Standards

Appeals Process

La. Rev. Stat. Ann. §22:1865 (West 2014)

Registration/Licensure

La. Rev. Stat. Ann. §22:1657 (West 2020)

La. Rev. Stat. Ann. §40:2865 (West 2019)

La. Rev. Stat. Ann. §40:2870 (West 2020)

Regulatory Agency/Enforcement

La. Rev. Stat. Ann. §22:1657.1 (West 2020)

La. Rev. Stat. Ann. §37:1257 (West 2019)

La. Rev. Stat. Ann. §40:2868 (West 2020)

La. Rev. Stat. Ann. §40:2871 (West 2020)

Reporting/Transparency Requirements

La. Rev. Stat. Ann. §22:1657.1 (West 2020)

La. Rev. Stat. Ann. §40:1253.2 (West 2018)

Spread Pricing

La. Rev. Stat. Ann. §22:1867 (West 2020)

La. Rev. Stat. Ann. §39:1648 (West 2018)

La. Rev. Stat. Ann. §40:2870 (West 2020)

Utilization Management Tools

La. Rev. Stat. Ann. §22:1053 (West 2020) (Step Therapy)

La. Rev. Stat. Ann. §22:1006.1 (West 2020) (Prior Authorization)

La. Rev. Stat. Ann. §40:2870 (West 2020) (Step Therapy) (Prior Authorization)

Other

La. Rev. Stat. Ann. §39:1600.1 (West 2021) (Reverse Auction)

La. Rev. Stat. Ann. §40:2869 (West 2019) (Pharmacy Benefit Manager Monitoring Council)

Provision

Statute

Cost Disclosure/Gag Clause

Md. [Insurance] Code Ann. §15–1611 (2022)

Fiduciary

Md. [Insurance] Code Ann. §15–1642 (2019)

Maximum Allowable Cost (MAC) Lists

Md. [Insurance] Code Ann. §15–1628.1 (2019)

Network Adequacy

Md. [Insurance] Code Ann. §15–1611.1 (2022)

Md. [Insurance] Code Ann. §15-1628 (2022)

Patient Steering

Md. [Insurance] Code Ann. §15–1611.1 (2022)

Pharmacy Reimbursement

Clawbacks

Md. [Insurance] Code Ann. §15–1612 (2022)

Md. [Insurance] Code Ann. §15–1628.3 (2022)

Md. [Insurance] Code Ann. §15–1631 (2019)

Pharmacy Auditing Standards

Appeals Process

Md. [Insurance] Code Ann. §15–1628.1 (2019)

Md. [Insurance] Code Ann. §15–1628.2 (2021)

Md. [Insurance] Code Ann. §15–1629 (2022)

Registration/Licensure

Md. [Insurance] Code Ann. §15–1604 (2018)

Regulatory Agency/Enforcement

Md. [Insurance] Code Ann. §15–1604 (2018)

Md. [Insurance] Code Ann. §15–1607 (2018)

Md. [Insurance] Code Ann. §15–1609 (2008)

Reporting/Transparency Requirements

Md. [Insurance] Code Ann. §15–1623 (2008)

Md. [Insurance] Code Ann. §15–1624 (2008)

Spread Pricing

 

Utilization Management Tools

Md. [Insurance] Code Ann. §15–1633.1 (2008) (Non-Medical Switching)

Md. [Insurance] Code Ann. §15–1634 (2008) (Non-Medical Switching)

Md. [Insurance] Code Ann. §15–1635 (2008) (Non-Medical Switching)

Md. [Insurance] Code Ann. §15–1636 (2008) (Non-Medical Switching)

Other

Md. [State Personnel & Pensions] Code Ann. §2–502.2 (2020) (Reverse Auction)

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

Mass. Gen. Laws Ann. ch. 175, §226 (West 2015)

Registration/Licensure

 

Regulatory Agency/Enforcement

 

Reporting/Transparency Requirements

Mass. Gen. Laws Ann. ch.176O, §21 (2018)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

Mich. Comp. Laws Ann. §550.910 (1985)

Regulatory Agency/Enforcement

Mich. Comp. Laws Ann. §550.950 (1985)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Minn. Stat. Ann. §62W.11 (2021)

Minn. Stat. Ann. §151.214 (2019)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Minn. Stat. Ann. §62W.08 (2019)

Network Adequacy

Minn. Stat. Ann. §62W.05 (2019)

Patient Steering

Minn. Stat. Ann. §62W.07 (2019)

Pharmacy Reimbursement

Clawbacks

Minn. Stat. Ann. §62W.12 (2019)

Minn. Stat. Ann. §62W.13 (2019)

Pharmacy Auditing Standards

Appeals Process

Minn. Stat. Ann. §62W.09 (2019)

Registration/Licensure

Minn. Stat. Ann. §62W.03 (2019)

Regulatory Agency/Enforcement

Minn. Stat. Ann. §62W.03 (2019)

Reporting/Transparency Requirements

Minn. Stat. Ann. §62W.06 (2019)

Spread Pricing

Minn. Stat. Ann. §62W.06 (2019)

Utilization Management Tools

Minn. Stat. Ann. §62W.075 (2019) (Non-Medical Switching)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Miss. Code Ann. §73-21-205 (2018)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Miss. Code Ann. §73-21-156 (2021)

Network Adequacy

Miss. Code Ann. §73-21-161 (2021)

Patient Steering

Miss. Code Ann. §73-21-161 (2021)

Pharmacy Reimbursement

Clawbacks

Miss. Code Ann. §73-21-155 (2021)

Pharmacy Auditing Standards

Appeals Process

Miss. Code Ann. §73-21-183 (2012)

Miss. Code Ann. §73-21-185 (2012)

Registration/Licensure

Miss. Code Ann. §73-21-157 (2021)

Regulatory Agency/Enforcement

Miss. Code Ann. §73-21-155 (2021)

Miss. Code Ann. §73-21-159 (2021)

Miss. Code Ann. §73-21-163 (2021)

Miss. Code Ann. §73-21-191 (2012)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Mo. Rev. Stat. §376.387 (2020)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Mo. Rev. Stat. §376.388 (2016)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Mo. Rev. Stat. §376.387 (2020)

Pharmacy Auditing Standards

Appeals Process

Mo. Rev. Stat. §338.600 (2008)

Registration/Licensure

Mo. Rev. Stat. §376.393 (2020)

Regulatory Agency/Enforcement

Mo. Rev. Stat. §376.387 (2020)

Mo. Rev. Stat. §376.393 (2020)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

Mo. Rev. Stat. §376.392 (2008) (Formulary Deletions)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Mont. Code Ann. §33-22-174 (2022)

Mont. Code Ann. §33-2-2404 (2022)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Mont. Code Ann. §33-22-171-173 (2015-2019)

Network Adequacy

Mont. Code Ann. §33-2-2409 (2022)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Mont. Code Ann. §33-22-175 (2020)

Mont. Code Ann. §33-22-176 (2020)

Pharmacy Auditing Standards

Appeals Process

Mont. Code Ann. §33-22-177 (2020)

Registration/Licensure

Mont. Code Ann. §33-2-2403 (2022)

Regulatory Agency/Enforcement

Mont. Code Ann. §33-2-2403 (2022)

Mont. Code Ann. §33-2-2411 (2022)

Reporting/Transparency Requirements

Mont. Code Ann. §33-2-2406 (2022)

Mont. Code Ann. §33-2-2407 (2022)

Spread Pricing

 

Utilization Management Tools

 

Other

Mont. Code Ann. §33-2-2410 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Neb. Rev. Stat. §71-2484 (2019)

Fiduciary

 

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

Neb. Rev. Stat. §44-7, 111 (2021) to Neb. Rev. Stat. §44-7, 117 (2021) (Step Therapy)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Nev. Rev. Stat. §683A.179(1)a (2022)

Fiduciary

Nev. Rev. Stat. §683A.178 (2020)

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

Nev. Rev. Stat. §439B.645 (2021)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

N.H. Rev. Stat. Ann. §402-N:4 (2020)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

N.H. Rev. Stat. Ann. §402-N:3 (2020)

Network Adequacy

N.H. Rev. Stat. Ann. §402-N:4-a (2021)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

N.H. Rev. Stat. Ann. §402-N:4 (2020)

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

N.H. Rev. Stat. Ann. §402-N:2 (2020)

Regulatory Agency/Enforcement

N.H. Rev. Stat. Ann. §402-N:2 (2020)

N.H. Rev. Stat. Ann. §402-N:7 (2020)

N.H. Rev. Stat. Ann. §402-N:5 (2021)

N.H. Rev. Stat. Ann. §402-N:2 (2020)

Reporting/Transparency Requirements

N.H. Rev. Stat. Ann. §402-N:6 (2020)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

N.J. Stat. Ann. §17B:27F-6(1)b

Fiduciary

N.J. Admin. Code § 11:23-3.4

Maximum Allowable Cost (MAC) Lists

N.J. Admin. Code §11:4-62.3

N.J. Stat. Ann. §17B:27F-2

N.J. Stat. Ann. §17B:27F-3

Network Adequacy

N.J. Stat. Ann. §17B:26-2.1i

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

N.J. Stat. Ann. §17B:27F-7

N.J. Stat. Ann. §17B-27F-6(1)a

Pharmacy Auditing Standards

Appeals Process

N.J. Admin. Code §11:4-62.4

N.J. Stat. Ann. §17B:27F-4

Registration/Licensure

N.J. Admin. Code §11:23-2.1—11:23.6

N.J. Stat. Ann. §17B:27B-2

Regulatory Agency/Enforcement

N.J. Admin. Code §11:4-62.5

N.J. Admin. Code §11:4-62.6

N.J. Admin. Code §11:23-3.2

N.J. Admin. Code §11:23-3.8

N.J. Admin. Code §11:23-4.1—4.3

N.J. Stat. Ann. §17B:27F-5

Reporting/Transparency Requirements

N.J. Rev. Stat. §30:4D-7ee

Spread Pricing

 

Utilization Management Tools

 

Other

N.J. Admin. Code §5:34-5.6 (Reverse Auction)

Provision

Statute

Cost Disclosure/Gag Clause

N.M. Stat. Ann. §59A-61-5E(3)(b) (2019)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

N.M. Stat. Ann. §59A-61-4 (2019)

Network Adequacy

N.M. Stat. Ann. §59A-61-5(H) (2019)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

N.M. Stat. Ann. §59A-61-4(B) (2019)

N.M. Stat. Ann. §59A-61-7 (2019)

Pharmacy Auditing Standards

Appeals Process

N.M. Stat. Ann. §59A-61-4(D)(4) (2019)

Registration/Licensure

N.M. Stat. Ann. §59A-61-3 (2019)

Regulatory Agency/Enforcement

N.M. Stat. Ann. §59A-61-3 (2019)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

N.M. Stat. Ann. §59A-22B-4 (2019) (Uniform Prior Authorization)

N.M. Stat. Ann. §59A-22B-5 (2019) (Prior Authorization)

N.M. Stat. Ann. §59A-22-53.1 (2018) (Step Therapy)

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

N.C. Gen. Stat. §58-56A-3 (2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

N.C. Gen. Stat. §58-56A-5 (2021)

Network Adequacy

N.C. Gen. Stat. §58-51-37 (2021)

N.C. Gen. Stat. §58-56A-15 (2021)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

N.C. Gen. Stat. §58-56A-4 (2021)

Pharmacy Auditing Standards

Appeals Process

N.C. Gen. Stat. §90-85.50 (2013)

Registration/Licensure

N.C. Gen. Stat. §58‑56A‑2 (2021)

Regulatory Agency/Enforcement

N.C. Gen. Stat. §58-56A-10 (2021)

N.C. Gen. Stat. §58-56A-25 (2021)

N.C. Gen. Stat. §58-56A-30 (2021)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

N.C. Gen. Stat. §58-3-221 (2020) (Exception Process)

Other

N.C. Gen. Stat. §58-51-37 (2021) (340B)

N.C. Gen. Stat. §58-56A-50 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

N.D. Cent. Code §19-02.1-16.1(7) (2017)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

N.D. Cent. Code §19-02.1-14.2 (2013)

Network Adequacy

N.D. Cent. Code §19-02.1-16.2 (2017)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

N.D. Cent. Code §19-02.1-16.1 (2017)

Pharmacy Auditing Standards

Appeals Process

N.D. Cent. Code §19-03.6-02 (2011)

N.D. Cent. Code §19-03.6-03 (2011)

Registration/Licensure

N.D. Cent. Code §26.1-27.1-02 (2005)

Regulatory Agency/Enforcement

N.D. Cent. Code §26.1-27.1-07 (2005)

N.D. Cent. Code §26.1-36.10-06 (2021)N.D. Cent. Code §26.1-36.10-08 (2021)

Reporting/Transparency Requirements

N.D. Cent. Code §26.1-36.10.03 (2021)

Spread Pricing

 

Utilization Management Tools

N.D. Cent. Code §19-02.1-16.3 (2019) (Step Therapy)

Other

N.D. Cent. Code §19-02.1-16.5 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Okla. Stat. Ann. tit. 36, 6962(C)(1) (2019)

Okla. Stat. Ann. tit. 59, §359 (2021)

Fiduciary

Okla. Stat. Ann. tit. 36, §1445 (2021)

Maximum Allowable Cost (MAC) Lists

Okla. Stat. Ann. tit. 59, §360 (2021)

Network Adequacy

Okla. Stat. Ann. tit. 36, §6961 (2019)

Okla. Stat. Ann. tit. 36, §6963(B)(4)(C) (2019)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Okla. Stat. Ann. tit. 36, §6962(B) (2019)

 

Pharmacy Auditing Standards

Appeals Process

Okla. Stat. Ann. tit. 59, § 356.1-.356.5 (2021)

Registration/Licensure

Okla. Stat. Ann. tit. 59, §358 (2021)

Regulatory Agency/Enforcement

Okla. Stat. Ann. tit. 36, § 6965 (2021)

Okla. Stat. Ann. tit. 36 § 6966 (2021)

Okla. Stat. Ann. tit. 59, §358 (2021)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Or. Rev. Stat. §735.536(2)(f) (2019)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Or. Rev. Stat. §735.534 (2019)

Network Adequacy

 

Patient Steering

Or. Rev. Stat. §735.536 (2019)

Pharmacy Reimbursement

Clawbacks

Or. Rev. Stat. §735.536 (2019)

Pharmacy Auditing Standards

Appeals Process

Or. Rev. Stat. §735.534(4) (2019)

Or. Rev. Stat. §735.542 (2013)

Registration/Licensure

Or. Rev. Stat. §735.532 (2017)

Regulatory Agency/Enforcement

Or. Rev. Stat. §735.532 (2017)

Or. Rev. Stat. §735.533 (2017)

Or. Rev. Stat. §735.552 (2013)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

Or. Rev. Stat. §743B.420 (2021) (Prior Authorization)

Or. Rev. Stat. §743B.422 (2021) (Prior Authorization)

Or. Rev. Stat. §743B.423 (2021) (Prior Authorization)

Or. Rev. Stat. §743B.425 (2021) (Prior Authorization)

Or. Rev. Stat. §743B.602 (2021) (Step-Therapy)

Or. Rev. Stat. §414.772 (2019) (Step-Therapy)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

 Pa. Act 67 §3 (2020)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Pa. Act 169 Ch. 7 §701 (2016)

Network Adequacy

 

Patient Steering

Pa. Act 120 Ch. 7 §449(2g) (2020)

Pharmacy Reimbursement

Clawbacks

Pa. Act 120 Ch. 7 §449 (2020)

Pa. Act 169 Ch. 7 §701 (2016)

Pharmacy Auditing Standards

Appeals Process

Pa. Act 120 Ch. 7 §449 (2020)

Pa. Act 169 Ch. 3 §301 (2016)

Pa. Act 169 Ch. 7 §701 (2016)

Registration/Licensure

Pa. Act 169 Ch. 5 §501 (2016)

Regulatory Agency/Enforcement

Pa. Act 169 Ch. 9 §901 (2016)

Reporting/Transparency Requirements

Pa. Act 120 Ch. 9 §449 (2020)

Spread Pricing

Pa. Act 120 Ch. 9 §449 (2020)

Utilization Management Tools

 

Other

 

Provision

Statute

Cost-Disclosure/Gag-Clause

R.I. Gen. Laws §27-20.8-4 (2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

R.I. Gen. Laws § 27-18-33.2 (2016)

R.I. Gen. Laws § 27-41-38.2 (2016)

Network Adequacy

R.I. Gen. Laws §27-29.1-3 (2004)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

R.I. Gen. Laws §5-19.1-35 (2019)

Registration/Licensure

R.I. Gen. Laws §27-20.7-12 (2001)

Regulatory Agency/Enforcement

R.I. Gen. Laws §27-29.1-8 (2004)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

S.C. Code Ann. §38-71-2220 (Law. Co-op 2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

S.C. Code Ann. §38-71-2240 (Law. Co-op 2021)

Network Adequacy

S.C. Code Ann. §38-71-147 (Law. Co-op 1997)

S.C. Code Ann. §38-71-2230(E) (Law. Co-op 2021)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

S.C. Code Ann. §38-71-2230 (Law. Co-op 2021)

S.C. Code Ann. §38-71-1830 (Law. Co-op 2013)

Pharmacy Auditing Standards

Appeals Process

S.C. Code Ann. §38-71-1810 (Law. Co-op 2019)

S.C. Code Ann. §38-71-1820 (Law. Co-op 2013)

Registration/Licensure

S.C. Code Ann. §38-71-2210 (Law. Co-op 2021)

Regulatory Agency/Enforcement

S.C. Code Ann. §38-71-2210 (Law. Co-op 2021)

S.C. Code Ann. §38-71-2250 (Law. Co-op 2021)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

S.D. Codified Laws Ann. §58-29E-8.1 (2018)

S.D. Codified Laws Ann. §58-33-135 (2018)

Fiduciary

S.D. Codified Laws Ann. §58-29E-3 (2004)

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

S.D. Codified Laws Ann. §58-29E-12 (2019)

S.D. Codified Laws Ann. §58-29E-13 (2019)

S.D. Codified Laws Ann. §58-29F-6 (2013)

Pharmacy Auditing Standards

Appeals Process

S.D. Codified Laws Ann. §58-29F3-F5 (2013)

S.D. Codified Laws Ann. §58-29F-9 (2013)

Registration/Licensure

S.D. Codified Laws Ann. §58-29E-2 (2013)

Regulatory Agency/Enforcement

S.D. Codified Laws Ann. §58-29E-9 (2004)

Reporting/Transparency Requirements

S.D. Codified Laws Ann. §58-29E-4 (2004)

Spread Pricing

 

Utilization Management Tools

 

Other

S.D. Codified Laws Ann. §58-29E-15 (2019) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Tenn. Code Ann. §56-7-3114 (2018)

Tenn. Code Ann. §56-7-3203 (2010)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Tenn. Code Ann. §56-7-3106 (2015)

Tenn. Code Ann. §56-7-3107 (2015)

Tenn. Code Ann. §56-7-3108 (2016)

Network Adequacy

 

Patient Steering

Tenn. Code Ann. §56-7-3120 (2021)

Pharmacy Reimbursement

Clawbacks

Tenn. Code Ann. §56-7-3104 (2007)

Tenn. Code Ann. §56-7-3112 (2015)

Tenn. Code Ann. §56-7-3118 (2019)

Pharmacy Auditing Standards

Appeals Process

Tenn. Code Ann. §56-7-3103 (2019)

Registration/Licensure

Tenn. Code Ann. §56-7-3113 (2019)

Regulatory Agency/Enforcement

Tenn. Code Ann. §56-7-3113 (2019)

Reporting/Transparency Requirements

Tenn. Code Ann. §4-3-1021 (2013)

Spread Pricing

 

Utilization Management Tools

 

Other

Tenn. Code Ann. §56-7-3119 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Utah Code Ann. §31A-46-302 4(a) (2020)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Utah Code Ann. §31A-46-303 (2020)

Network Adequacy

Utah Code Ann. §31A-46-306 (2020)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Utah Code Ann. §31A-46-304 (2020)

Utah Code Ann. §31A-46-305 (2020)

Utah Code Ann. §34A-46-309 (2020)

Pharmacy Auditing Standards

Appeals Process

 

Registration/Licensure

Utah Code Ann. §31A-46-201 (2019)

Regulatory Agency/Enforcement

Utah Code Ann. §31A-46-202 (2019)

Utah Code Ann. §31A-2-308 (2019)

Reporting/Transparency Requirements

Utah Code Ann. §31A-46-301 (2020)

Utah Code Ann. §31A-46-307 (2020)

Spread Pricing

 

Utilization Management Tools

 

Other

Utah Code Ann. §34A-46-309 (2020) (340)

Utah Code Ann. §31A-46-310 (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Vt. Stat. Ann. tit. 18,  §9473 (b4, b5) (2021)

Fiduciary

Vt. Stat. Ann. tit. 18, §9472 (2014)

Maximum Allowable Cost (MAC) Lists

Vt. Stat. Ann. tit. 18, §9473 (c) (2021)

Network Adequacy

Vt. Stat. Ann. tit. 8, §4089j (2016)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Vt. Stat. Ann. tit. 18, §9473 (2021)

Pharmacy Auditing Standards

Appeals Process

Vt. Stat. Ann. tit. 18, §3802 (2021)

Registration/Licensure

Vt. Stat. Ann. tit. 18, §9421 (a) (2017)

Regulatory Agency/Enforcement

Vt. Stat. Ann. tit. 18, §9421 (a) (2017)

Vt. Stat. Ann. tit. 18, §9421 (e) (2017)

Vt. Stat. Ann. tit. 18, §9474 (2017)

Reporting/Transparency Requirements

Vt. Stat. Ann. tit. 18, §9472 (2014)

Spread Pricing

Vt. Stat. Ann. tit. 18, §9421 (b) (2017)

Vt. Stat. Ann. tit. 18, §9472 (2014)

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

 Va. Code §38.2-3407.15:4 (2018)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Va. Code §38.2-3407.15:3 (2015)

Network Adequacy

Va. Code §38.2-3407.7 (2021)

Va. Code §38.2-3467(C) (2020)

Patient Steering

Va. Code §38.2-4312.1 (2021)

Pharmacy Reimbursement

Clawbacks

Va. Code §38.2-3467(A)(3) (2020)

Pharmacy Auditing Standards

Appeals Process

Va. Code §38.2-3407.15:1 (2019)

Registration/Licensure

Va. Code §38.2-3466 (2020)

Regulatory Agency/Enforcement

Va. Code §38.2-3466 (2020)

Va. Code §38.2-3469 (2020)

Reporting/Transparency Requirements

Va. Code §38.2-3407.15:6 (2022)

Va. Code §38.2-3468 (2020)

Spread Pricing

Va. Code §38.2-3467(D) (2020)

Utilization Management Tools

Va. Code §38.2-3407.9:05 (2020) (Step Therapy)

Va. Code §38.2-3407.15:2 (2021) (Prior Authorization)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

 

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Wash. Rev. Code Ann. §48.200.280 (2022)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Wash. Rev. Code Ann. §48.200.280 (2022)

Pharmacy Auditing Standards

Appeals Process

Wash. Rev. Code Ann. §48.200.220 (2022)

Wash. Rev. Code Ann. §48.200.230 (2022)

Wash. Rev. Code Ann. §48.200.240 (2022)

Wash. Rev. Code Ann. §48.200.250 (2022)

Wash. Rev. Code Ann. §48.200.260 (2022)

Registration/Licensure

Wash. Rev. Code Ann. §19.340.030 (2022)

Wash. Rev. Code Ann. §48.200.030 (2022)

Regulatory Agency/Enforcement

Wash. Rev. Code Ann. §48.200.030 (2022)

Wash. Rev. Code Ann. §48.200.900 (2022)

Wash. Rev. Code Ann. §48.200.290 (2022)

Wash. Rev. Code Ann. §48.200.050 (2022)

Reporting/Transparency Requirements

Wash. Rev. Code Ann. §43.71C.030 (2022)

Spread Pricing

 

Utilization Management Tools

 

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

W. Va. Code §33-51-9(a) (2021)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

 

Network Adequacy

W. Va. Code §33-51-8(d) (2021)

Patient Steering

W. Va. Code §33-51-11 (2021)

Pharmacy Reimbursement

Clawbacks

W. Va. Code §5-16-7G(i) (2020)

This law is specific to cost-sharing requirements for insulin.

W. Va. Code §33-51(9) (2021)

Pharmacy Auditing Standards

Appeals Process

W. Va. Code §33-51-4 (2019)

W. Va. Code §33-51-5 (2017)

W. Va. Code §33-51-6 (2017)

Registration/Licensure

W. Va. Code §33-51-7 (2019)

W. Va. Code §33-51-8 (c) (2021)

Regulatory Agency/Enforcement

W. Va. Code §33-51-8(a) (2021)

W. Va. Code §33-51-8(e) (2021)

W. Va. Code §33-51-10 (2020)

Reporting/Transparency Requirements

W. Va. Code §33-51-12 (2021)

Spread Pricing

 

Utilization Management Tools

 

Other

 W. Va. Code §33-51-9(d) (2021) (340B)

Provision

Statute

Cost Disclosure/Gag Clause

Wis. Stat. §632.861(2)(a) (2021)  

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Wis. Stat. §632.865 (2) (2021)

Network Adequacy

Wis. Stat. §632.865 (4) (2021)

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

Wis. Stat. §632.865 (5) (2021)

Pharmacy Auditing Standards

Appeals Process

Wis. Stat. §632.865 (6) (2021)

Registration/Licensure

Wis. Stat. §632.865 (3) (2021)

Regulatory Agency/Enforcement

Wis. Stat. §632.865 (3) (2021)

Reporting/Transparency Requirements

Wis. Stat. §632.865(7) (2021)

Spread Pricing

 

Utilization Management Tools

Wis. Stat. §632.853 (1997) (Formulary Exception)

Wis. Stat. §632.866 (2019) (Step-Therapy)

Other

 

Provision

Statute

Cost Disclosure/Gag Clause

Wyo. Stat. §26-52-104(j) (2019)

Fiduciary

 

Maximum Allowable Cost (MAC) Lists

Wyo. Stat. §26-52-104 (2019)

Network Adequacy

 

Patient Steering

 

Pharmacy Reimbursement

Clawbacks

 

Pharmacy Auditing Standards

Appeals Process

Wyo. Stat. §26-52-103 (2016)

Registration/Licensure

Wyo. Stat. §26-52-101 (2016)

Regulatory Agency/Enforcement

Wyo. Stat. §26-52-101 (2016)

Reporting/Transparency Requirements

 

Spread Pricing

 

Utilization Management Tools

 

Other

 

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

 

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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