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fee-for-service reimbursement rates.
(c) The reimbursement rate for prescription medications
shall include a professional dispensing fee, which shall equal
the fee-for-service professional dispensing fee utilized by
(d) The Department shall require a managed care
organization, including any pharmacy benefits manager, to
reimburse pharmacies for patient care services provided by a
pharmacist at no less than 85% of the fee schedule for
(e) Any pharmacy provider may appeal the reimbursement rate
for prescription medications or patient care services.
(1) The Department shall have the authority to require
the managed care organization or pharmacy benefits manager
to submit information to the Department related to the
managed care organization's or pharmacy benefits manager's
pricing methodology and rationale.
(2) The managed care organization or pharmacy benefits
manager must respond to the request for information no
later than 7 days after the date upon which the request is
made. If the managed care organization or pharmacy benefits
manager does not respond to the Department's request within
7 days after the date upon which the request is made, the
Department shall render a final decision in favor of the
(f) At no time shall a pharmacy provider that contracts
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with a managed care organization or pharmacy benefits manager
be forced to dispense any prescription medication for a
reimbursement rate below the actual acquisition cost.
(g) The contracting of pharmacy providers shall be
separated from any other group or national pharmacy provider
contract offered by a pharmacy benefits manager.
(h) Medicaid pharmacy provider participation must remain
voluntary, as under the fee-for-service medical assistance
(i) A pharmacy benefits manager shall not require a
pharmacy provider to participate in a Medicaid managed care
organization's provider network.
(j) A pharmacy provider may decline to participate in a
contract with a pharmacy benefits manager and remain a
(k) No later than January 1, 2019, the Auditor General
shall initiate an audit of Medicaid managed care organizations
contracted with the Department and pharmacy benefits managers
contracted with Medicaid managed care organizations to
determine if their reimbursement methodologies are fair and to
determine the amount of Medicaid dollars retained by the
pharmacy benefits managers.
This Act takes effect upon