Delaware Code Title 18 Sec. 3372A – Prohibited practices
A pharmacy benefits manager or representative of a pharmacy benefits manager may not do any of the following:
(1) Engage in spread pricing.
(2) Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.
(3) Unless reviewed and approved by the Commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including a fee for any of the following:
a. The receipt and processing of a pharmacy claim.
b. The development or management of claims processing services in a pharmacy benefits manager network.
c. Participation in a pharmacy benefits manager network.
(4) Unless reviewed and approved by the Commissioner in coordination with the Board of Pharmacy, require pharmacy accreditation standards or certification requirements inconsistent with, more stringent than, or in addition to requirements of the Board of Pharmacy.
(5) Violate § 3325A(b) of this title.
(6) Violate § 3362A of this title.
(7) Pay or reimburse a pharmacy or pharmacist for the ingredient drug product component of pharmacist services less than the national average drug acquisition cost, or if the national average drug acquisition cost is unavailable, the wholesale acquisition cost.
(8) Make or permit any reduction of payment for pharmacy goods or services by a pharmacy benefits manager or an insurer directly or indirectly to a pharmacy under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payment.
(9) After adjudication of a claim for pharmacy goods or services, directly or indirectly retroactively deny or reduce the claim unless 1 or more of the following applies:
a. The original claim was intentionally submitted fraudulently.
b. The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacy goods or services.
c. The pharmacy goods or services were not properly rendered by the pharmacy or pharmacist.
