AN ACT
ENTITLED, An Act to revise certain provisions regarding pharmacy benefit managers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That chapter 58-29E be amended by adding a NEW SECTION to read:
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That chapter 58-29E be amended by adding a NEW SECTION to read:
No pharmacy benefit manager shall contractually require a pharmacy, who is a participating
provider in a health plan provided by a covered entity, to charge or collect from an insured a cost
share for a prescription or pharmacy service that exceeds the amount retained by the pharmacist or
pharmacy from all payment sources for the filling of the prescription or providing the pharmacy
service.
Section 2. That chapter 58-29E be amended by adding a NEW SECTION to read:
Section 2. That chapter 58-29E be amended by adding a NEW SECTION to read:
No pharmacy benefit manager contracting with a covered entity shall retroactively adjust a claim
for reimbursement submitted by a pharmacy for a prescription drug unless the adjustment is a result
of either of the following:
(1) A pharmacy audit conducted in accordance with chapter 58-29F; or
(2) A technical billing error.
Section 3. That chapter 58-29E be amended by adding a NEW SECTION to read:
Section 3. That chapter 58-29E be amended by adding a NEW SECTION to read:
Nothing in this Act shall prohibit a pharmacy benefit manager from adjusting claim payment for
the benefit of a covered individual if there was an error in the adjudication of a claim submitted by
or on behalf of the covered individual.
Section 4. That chapter 58-29E be amended by adding a NEW SECTION to read:
Section 4. That chapter 58-29E be amended by adding a NEW SECTION to read:
No pharmacy benefit manager may discriminate against a pharmacy participating in a health plan
as an entity authorized to participate under section 340B of the Public Health Service Act, as
amended to January 1, 2019, or any pharmacy under contract with such an entity to provide
prescriptions. For the purposes of this chapter, a retail pharmacy is any pharmacy licensed under the
An Act to revise certain provisions regarding pharmacy benefit managers.
laws of this state, and no pharmacy benefit manager may, by contract, modify that definition.
An Act to revise certain provisions regarding pharmacy benefit managers.
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I certify that the attached Act originated in the
HOUSE as Bill No. 1137
____________________________
Chief Clerk ____________________________
Speaker of the House
Attest:
____________________________
Chief Clerk
____________________________
Attest:
____________________________
Secretary of the Senate
House Bill No. 1137 File No. ____ Chapter No. ______ |
Received at this Executive Office this _____ day of _____________ ,
20____ at ____________ M.
By _________________________
for the Governor
The attached Act is hereby
approved this ________ day of
______________ , A.D., 20___
____________________________
Governor STATE OF SOUTH DAKOTA, ss.
Office of the Secretary of State
Filed ____________ , 20___
____________________________ Secretary of State
By _________________________ |
