Title 5
Businesses and Professions

CHAPTER 19.3
Defending Affordable Prescription Drug Costs Act

§ 5-19.3-3. Prohibition of certain discriminatory actions related to reimbursement of 340B covered entities and 340B contract pharmacies.

(a) With respect to reimbursement to a 340B covered entity for 340B drugs, a health insurer, pharmacy benefit manager, manufacturer, other third-party payor, or its agent shall not do any of the following:

(1) Establish a lower reimbursement amount to a 340B covered entity or 340B contract pharmacy for a 340B drug than it would be paid for a non-340B drug, based solely on the drug’s 340B status;

(2) Impose fees, chargebacks, adjustments, or conditions on reimbursement to a 340B covered entity, that differs from such terms or conditions applied to a non-340B entity, based on 340B status and participation in the federal 340B drug discount program set forth in 42 U.S.C. § 256b;

(3) Deny or limit participation in standard or preferred pharmacy networks based on 340B status;

(4) Impose requirements relating to the frequency or scope of audits of inventory management systems inconsistent with the federal 340B drug pricing program;

(5) Require submission of claims-level data or documentation that identifies 340B drugs as a condition of reimbursement or pricing, unless it is required by the Centers for Medicare and Medicaid Services;

(6) Require a 340B covered entity to reverse, resubmit, or clarify a claim after the initial adjudication unless these actions are in the normal course of pharmacy business and not related to 340B drug pricing;

(7) Interfere with, or limit, a 340B covered entity’s choice to use a contract pharmacy for drug distribution or dispensing;

(8) Include any other provision in a contract between a health insurer, pharmacy benefit manager, manufacturer, or other third-party payor and a 340B covered entity that differ from the terms and conditions applied to entities that are not 340B covered entities, that discriminates against the 340B covered entity or prevents or interferes with an individual’s choice to receive a prescription drug from a 340B covered entity, including the administration of such drugs in person or via direct delivery, mail, or other form of shipment, or create a restriction or additional charge on a patient who chooses to receive drugs from a 340B covered entity;

(9) Place a restriction or additional charge on a patient who chooses to receive 340B drugs from a 340B covered entity if such restriction or additional charge differs from the terms and conditions applied where patients choose to receive drugs that are not 340B drugs from an entity that is not a 340B covered entity or from a pharmacy that is not a 340B contract pharmacy;

(10) Exclude any 340B covered entity from a health insurer, pharmacy benefit manager, or other third-party payor network or refuse to contract with a 340B covered entity for reasons other than those that apply equally to a non-340B entity;

(11) Impose any other restrictions, requirements, practices, or policies that are not imposed on a non-340B entity.

(b) Nothing in this section is intended to limit a health insurer or pharmacy benefit manager’s ability to use preferred pharmacies or develop preferred networks so long as participation is not based on an entity’s status as a 340B covered entity and participation in the network is subject to the same terms and conditions as a non-340B covered entity.