49-20-421. Prescription discount program.
(1) |
As used in this section:
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Terms Used In Utah Code 49-20-421- Participant: means an individual with voluntary deferrals or nonelective contributions on deposit with the defined contribution plans administered under this title. See Utah Code 49-11-102
- Program: means the Public Employees' Benefit and Insurance Program. See Utah Code 49-20-102
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(a) |
“Discount program” means the prescription discount program created by this section. |
(b) |
“Epinephrine auto-injector” means the same as that term is defined in Section 26B-4-401. |
(c) |
“Insulin” means a prescription drug that contains insulin. |
(d) |
“Participant” means a resident of Utah who:
(i) |
has a prescription or standing prescription for a qualified prescription; |
(ii) |
does not receive health coverage under the program; and |
(iii) |
enrolls in the discount program. |
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(e) |
“Prescription drug” means the same as that term is defined in Section 58-17b-102. |
(f) |
“Qualified prescription” means a prescription drug, including insulin and epinephrine auto-injectors, that the program has determined:
(i) |
treats a serious, prevalent, and ongoing condition; |
(ii) |
does not have a generic substitute; |
(iii) |
qualifies for a substantial rebate; and |
(iv) |
would not result in financial losses to the state risk pool if sold as part of the discount program. |
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(g) |
“Rebate” means the same as that term is defined in Section 31A-46-102. |
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(2) |
The program shall create a prescription discount program for a participant to purchase a qualified prescription at a discounted, post-rebate price. |
(3) |
The program shall:
(a) |
provide a participant with a card or electronic document that identifies the participant as eligible for the discount on a qualified prescription; |
(b) |
provide a participant with information about pharmacies that will honor the discount; and |
(c) |
provide a participant with instructions to pursue a reimbursement of the purchase price from the participant’s health insurer. |
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(4) |
The program may not retain any amount of a rebate for a qualified prescription except for an amount necessary to make the state risk pool whole for providing the qualified prescription to participants. |
(5) |
For each drug added to the discount program, the program shall notify the Health and Human Services Interim Committee, providing:
(a) |
the name of the drug; and |
(b) |
the primary condition the drug treats. |
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Amended by Chapter 267, 2023 General Session
Amended by Chapter 328, 2023 General Session