Alabama § 27-45A-13 - Pharmacy Benefits Managers -- Prohibited Activities Related to Independent Pharmacies; Exceptions.

§ 27-45A-13. Pharmacy Benefits Managers -- Prohibited Activities Related to Independent Pharmacies; Exceptions.

(a) Notwithstanding any other provision of this chapter or any form of a contract to the contrary, with respect to an independent pharmacy, a pharmacy benefits manager, directly or through an affiliate or a contracted third party, may not do any of the following:

(1) Reimburse for dispensing a prescription drug in an amount that is less than the Medicaid reimbursement rate.

(2) Impose a fee or otherwise adjust or lower the reimbursement of a drug at the time the claim is adjudicated, or after the claim is adjudicated, that in any way reduces the amount of reimbursement for the drug as regulated pursuant to subdivision (1).

(3) Increase a covered individual’s cost-sharing percentage or ratio at or after the point of sale by raising the deductible, copayment, or coinsurance, or by requiring any other out-of-pocket payment as a means to recoup the dispensing cost portion of the reimbursement required pursuant to subdivision (1).

(4) Reject payment of a claim for a drug that is submitted by an independent pharmacy when the drug is available to a covered individual at a different in-network pharmacy; provided, however, if the drug is dispensed by the different in-network pharmacy, the pharmacy benefits manager shall pay the independent pharmacy a surcharge equal to the reimbursement that would have been paid pursuant to subdivision (1) had the independent pharmacy dispensed the drug.

(b) A health benefit plan that covers individuals who are public employees and that reimburses independent pharmacies for dispensing prescription drugs during its plan year in an aggregate amount that is higher than would otherwise be calculated using the rate set in subdivision (a)(1), upon proof of the same submitted to the commissioner, shall be exempt from this section.