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2021 Utah Code
Title 31A - Insurance Code
Chapter 46 - Pharmacy Benefits Act
Part 3 - Operating Requirements
Section 310 - Prohibited actions with respect to a federally qualified health center.
Universal Citation:
UT Code § 31A-46-310 (2021)
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Effective 5/5/2021
31A-46-310. Prohibited actions with respect to a federally qualified health center.
Enacted by Chapter 317, 2021 General Session
31A-46-310. Prohibited actions with respect to a federally qualified health center.
- (1) As used in this section, "federally qualified health center":
- (a) means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and
- (b) includes the pharmacy or pharmacies that are operated by or contract with a federally qualified health center described in Subsection (1)(a) to dispense drugs purchased through the federally qualified health center.
- (2) This section applies to a contract entered into or renewed on or after January 1, 2022, between an insurer and a pharmacy described in Subsection (1)(b).
- (3) An insurer may not vary the amount that the insurer reimburses to a federally qualified health center for a drug on the basis of whether:
- (a) the drug is a 340B drug; or
- (b) the pharmacy is a 340B entity.
- (4) Subsection (3) does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.
- (5) An insurer or an insurer's pharmacy service entity may not:
- (a) on the basis that a federally qualified health center participates, directly or through a contractual arrangement, in the 340B drug discount program:
- (i) assess a fee, charge-back, or other adjustment on a federally qualified health center;
- (ii) restrict access to the insurer's pharmacy network;
- (iii) require the federally qualified health center to enter into a contract with a specific pharmacy to participate in the insurer's pharmacy network;
- (iv) create a restriction or an additional charge on a patient who chooses to receive drugs from a federally qualified health center; or
- (v) create any additional requirements or restrictions on the federally qualified health center; or
- (b) require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program.
- (a) on the basis that a federally qualified health center participates, directly or through a contractual arrangement, in the 340B drug discount program:
Enacted by Chapter 317, 2021 General Session
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