Terms Used In Utah Code > Title 31A > Chapter 46 - Pharmacy Benefits Act

• Abusive conduct: means verbal, nonverbal, or physical conduct of an employee to another employee of the same employer that, based on the severity, nature, or frequency of the conduct, a reasonable person would determine:
            (1)(a)(i) is intended to cause intimidation, humiliation, or unwarranted distress;
            (1)(a)(ii) results in substantial physical harm or substantial psychological harm as a result of intimidation, humiliation, or unwarranted distress; or
            (1)(a)(iii) exploits an employee's known physical or psychological disability. See Utah Code 67-26-102
• Abusive conduct complaint process: means the process described in Section 67-26-202. See Utah Code 67-26-102
• Administrative fee: means any payment, other than a rebate, that a pharmaceutical manufacturer makes directly or indirectly to a pharmacy benefit manager. See Utah Code 31A-46-102
• Administrative review process: means a process that allows an employee, in relation to the findings of an abusive conduct investigation, to seek an administrative review that:
       (3)(a) an employer conducts in accordance with Section 67-26-202; or
       (3)(b) in relation to a state executive branch agency, the Career Service Review Office conducts in accordance with Section 67-19a-501. See Utah Code 67-26-102
• Affected entity: means a county, municipality, special district, special service district under Title 17D, Chapter 1, Special Service District Act, school district, interlocal cooperation entity established under Title 11, Chapter 13, Interlocal Cooperation Act, specified property owner, property owner's association, public utility, or the Department of Transportation, if:
       (3)(a) the entity's services or facilities are likely to require expansion or significant modification because of an intended use of land;
       (3)(b) the entity has filed with the county a copy of the entity's general or long-range plan; or
       (3)(c) the entity has filed with the county a request for notice during the same calendar year and before the county provides notice to an affected entity in compliance with a requirement imposed under this chapter. See Utah Code 17-27a-103
• Affiliate: means a person who controls, is controlled by, or is under common control with, another person. See Utah Code 31A-1-301
• Allowable claim amount: means the amount paid by an insurer under the customer's health benefit plan. See Utah Code 31A-46-102
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Application: means a document:
       (10)(a)

            (10)(a)(i) completed by an applicant to provide information about the risk to be insured; and

            (10)(a)(ii) that contains information that is used by the insurer to evaluate risk and decide whether to:

                 (10)(a)(ii)(A) insure the risk under:

                      (10)(a)(ii)(A)(I) the coverage as originally offered; or

                      (10)(a)(ii)(A)(II) a modification of the coverage as originally offered; or

                 (10)(a)(ii)(B) decline to insure the risk; or
       (10)(b) used by the insurer to gather information from the applicant before issuance of an annuity contract. See Utah Code 31A-1-301
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
• Career service employee: means the same as that term is defined in Section 63A-17-102. See Utah Code 67-27-102
• City: includes , depending on population, a metro township as defined in Section 10-3c-102. See Utah Code 68-3-12.5
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Contracting insurer: means an insurer with whom a pharmacy benefit manager contracts to provide a pharmacy benefit management service. See Utah Code 31A-46-102
• Cost share: means the amount paid by an insured customer under the customer's health benefit plan. See Utah Code 31A-46-102
• County utility easement: means an easement that:
       (11)(a) a plat recorded in a county recorder's office described as a county utility easement or otherwise as a utility easement;
       (11)(b) is not a protected utility easement or a public utility easement as defined in Section 54-3-27;
       (11)(c) the county or the county's affiliated governmental entity owns or creates; and
       (11)(d)

            (11)(d)(i) either:

                 (11)(d)(i)(A) no person uses or occupies; or

                 (11)(d)(i)(B) the county or the county's affiliated governmental entity uses and occupies to provide a utility service, including sanitary sewer, culinary water, electrical, storm water, or communications or data lines; or

            (11)(d)(ii) a person uses or occupies with or without an authorized franchise or other agreement with the county. See Utah Code 17-27a-103
• Culinary water authority: means the department, agency, or public entity with responsibility to review and approve the feasibility of the culinary water system and sources for the subject property. See Utah Code 17-27a-103
• Department: means the Insurance Department. See Utah Code 31A-1-301
• Device: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Direct or indirect remuneration: means any adjustment in the total compensation:
       (9)(a) received by a pharmacy from a pharmacy benefit manager for the sale of a drug, device, or other product or service; and
       (9)(b) that is determined after the sale of the product or service. See Utah Code 31A-46-102
• Dismissal: The dropping of a case by the judge without further consideration or hearing. ^Source:
• Dispense: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Division: means the Division of Human Resource Management. See Utah Code 67-26-102
• Drug: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Employee: means a person who performs a service for wages or other remuneration under a contract of hire, written or oral, express or implied. See Utah Code 67-21-2
• Employee: includes an elected or appointed official of an employer. See Utah Code 67-26-102
• Employer: includes an agent of an employer. See Utah Code 67-21-2
• Employer: means :
       (6)(a) a state executive branch agency; or
       (6)(b) an independent entity, as defined in Section 63E-1-102. See Utah Code 67-26-102
• Enrollee: includes an insured. See Utah Code 31A-1-301
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Executive branch elected official: means :
       (2)(a) the governor;
       (2)(b) the lieutenant governor;
       (2)(c) the attorney general;
       (2)(d) the state treasurer; or
       (2)(e) the state auditor. See Utah Code 67-27-102
• Executive branch official: means an individual who:
       (3)(a) is a management level employee of an executive branch elected official; and
       (3)(b) is not a career service employee. See Utah Code 67-27-102
• Form: means one of the following prepared for general use:
            (74)(a)(i) a policy;
            (74)(a)(ii) a certificate;
            (74)(a)(iii) an application;
            (74)(a)(iv) an outline of coverage; or
            (74)(a)(v) an endorsement. See Utah Code 31A-1-301
• Fraud: Intentional deception resulting in injury to another.
• Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
• Individual: means a natural person. See Utah Code 31A-1-301
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
            (103)(a)(i) a policyholder;
            (103)(a)(ii) a subscriber;
            (103)(a)(iii) a member; and
            (103)(a)(iv) a beneficiary. See Utah Code 31A-1-301
• Insurer: means the same as that term is defined in Section 31A-22-636. See Utah Code 31A-46-102
• Internal lot restriction: means a platted note, platted demarcation, or platted designation that:
       (30)(a) runs with the land; and
       (30)(b)

            (30)(b)(i) creates a restriction that is enclosed within the perimeter of a lot described on the plat; or

            (30)(b)(ii) designates a development condition that is enclosed within the perimeter of a lot described on the plat. See Utah Code 17-27a-103
• Land: includes :
       (18)(a) land;
       (18)(b) a tenement;
       (18)(c) a hereditament;
       (18)(d) a water right;
       (18)(e) a possessory right; and
       (18)(f) a claim. See Utah Code 68-3-12.5
• Land use authority: means :
       (35)(a) a person, board, commission, agency, or body, including the local legislative body, designated by the local legislative body to act upon a land use application; or
       (35)(b) if the local legislative body has not designated a person, board, commission, agency, or body, the local legislative body. See Utah Code 17-27a-103
• Legislative: when used to describe the powers, duties, or functions of a county commission or council, refers to:
       (3)(a) the power and duty to enact ordinances, levy taxes, and establish budgets; and
       (3)(b) those powers, duties, and functions that, under constitutional and statutory provisions and through long usage and accepted practice and custom at the federal and state level, have come to be regarded as belonging to the legislative branch of government. See Utah Code 17-50-101
• Legislative body: means the county legislative body, or for a county that has adopted an alternative form of government, the body exercising legislative powers. See Utah Code 17-27a-103
• License: includes a certificate of authority issued to an insurer. See Utah Code 31A-1-301
• Lobbying: is a s defined in Section 36-11-102. See Utah Code 67-24-102
• Lobbyist: is a s defined in Section 36-11-102. See Utah Code 67-24-102
• Lot: means a tract of land, regardless of any label, that is created by and shown on a subdivision plat that has been recorded in the office of the county recorder. See Utah Code 17-27a-103
• Lot line adjustment: means a relocation of a lot line boundary between adjoining lots or between a lot and adjoining parcels in accordance with Section 17-27a-608:
            (41)(a)(i) whether or not the lots are located in the same subdivision; and
            (41)(a)(ii) with the consent of the owners of record. See Utah Code 17-27a-103
• Maximum allowable cost: means :
       (13)(a) a maximum reimbursement amount for a group of pharmaceutically and therapeutically equivalent drugs; or
       (13)(b) any similar reimbursement amount that is used by a pharmacy benefit manager to reimburse pharmacies for multiple source drugs. See Utah Code 31A-46-102
• Medicaid program: means the same as that term is defined in Section 26B-3-101. See Utah Code 31A-46-102
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Obsolete: means a product that may be listed in national drug pricing compendia but is no longer available to be dispensed based on the expiration date of the last lot manufactured. See Utah Code 31A-46-102
• Office: means the Career Service Review Office created under Section 67-19a-201. See Utah Code 67-26-102
• Parcel: means any real property that is not a lot. See Utah Code 17-27a-103
• Participating: means a plan of insurance under which the insured is entitled to receive a dividend representing a share of the surplus of the insurer. See Utah Code 31A-1-301
• Person: includes :
       (146)(a) an individual;
       (146)(b) a partnership;
       (146)(c) a corporation;
       (146)(d) an incorporated or unincorporated association;
       (146)(e) a joint stock company;
       (146)(f) a trust;
       (146)(g) a limited liability company;
       (146)(h) a reciprocal;
       (146)(i) a syndicate; or
       (146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301
• Person: means an individual, corporation, partnership, organization, association, trust, governmental agency, or any other legal entity. See Utah Code 17-27a-103
• Person: means :
       (24)(a) an individual;
       (24)(b) an association;
       (24)(c) an institution;
       (24)(d) a corporation;
       (24)(e) a company;
       (24)(f) a trust;
       (24)(g) a limited liability company;
       (24)(h) a partnership;
       (24)(i) a political subdivision;
       (24)(j) a government office, department, division, bureau, or other body of government; and
       (24)(k) any other organization or entity. See Utah Code 68-3-12.5
• Pharmaceutical facility: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Pharmaceutical manufacturer: means a pharmaceutical facility that manufactures prescription drugs. See Utah Code 31A-46-102
• Pharmacist: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Pharmacy: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Pharmacy benefit manager: means a person licensed under this chapter to provide a pharmacy benefits management service. See Utah Code 31A-46-102
• Pharmacy benefits management service: means any of the following services provided to a health benefit plan, or to a participant of a health benefit plan:
       (21)(a) negotiating the amount to be paid by a health benefit plan for a prescription drug; or
       (21)(b) administering or managing a prescription drug benefit provided by the health benefit plan for the benefit of a participant of the health benefit plan, including administering or managing:

            (21)(b)(i) an out-of-state mail service pharmacy;

            (21)(b)(ii) a specialty pharmacy;

            (21)(b)(iii) claims processing;

            (21)(b)(iv) payment of a claim;

            (21)(b)(v) retail network management;

            (21)(b)(vi) clinical formulary development;

            (21)(b)(vii) clinical formulary management services;

            (21)(b)(viii) rebate contracting;

            (21)(b)(ix) rebate administration;

            (21)(b)(x) a participant compliance program;

            (21)(b)(xi) a therapeutic intervention program;

            (21)(b)(xii) a disease management program; or

            (21)(b)(xiii) a service that is similar to, or related to, a service described in Subsection (21)(a) or (21)(b)(i) through (xii). See Utah Code 31A-46-102
• Pharmacy service: means a product, good, or service provided to an individual by a pharmacy or pharmacist. See Utah Code 31A-46-102
• Pharmacy service entity: means :
       (25)(a) a pharmacy services administration organization; or
       (25)(b) a pharmacy benefit manager. See Utah Code 31A-46-102
• Pharmacy services administration organization: means an entity that contracts with a pharmacy to assist with third-party payer interactions and administrative services related to third-party payer interactions, including:
       (24)(a) contracting with a pharmacy benefit manager on behalf of the pharmacy; and
       (24)(b) managing a pharmacy's claims payments from third-party payers. See Utah Code 31A-46-102
• Physical harm: means the impairment of an individual's physical health or bodily integrity, as established by competent evidence. See Utah Code 67-26-102
• Plat: means an instrument subdividing property into lots as depicted on a map or other graphical representation of lands that a licensed professional land surveyor makes and prepares in accordance with Section 17-27a-603 or 57-8-13. See Utah Code 17-27a-103
• Prescription device: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Prescription drug: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
• Property: includes both real and personal property. See Utah Code 68-3-12.5
• Psychological harm: means the impairment of an individual's mental health, as established by competent evidence. See Utah Code 67-26-102
• Public hearing: means a hearing at which members of the public are provided a reasonable opportunity to comment on the subject of the hearing. See Utah Code 17-27a-103
• Public meeting: means a meeting that is required to be open to the public under Title 52, Chapter 4, Open and Public Meetings Act. See Utah Code 17-27a-103
• Public street: means a public right-of-way, including a public highway, public avenue, public boulevard, public parkway, public road, public lane, public alley, public viaduct, public subway, public tunnel, public bridge, public byway, other public transportation easement, or other public way. See Utah Code 17-27a-103
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• real property: includes :
       (31)(a) land;
       (31)(b) a tenement;
       (31)(c) a hereditament;
       (31)(d) a water right;
       (31)(e) a possessory right; and
       (31)(f) a claim. See Utah Code 68-3-12.5
• Rebate: means a refund, discount, or other price concession that is paid by a pharmaceutical manufacturer to a pharmacy benefit manager based on a prescription drug's utilization or effectiveness. See Utah Code 31A-46-102
• Record of survey map: means a map of a survey of land prepared in accordance with Section 10-9a-603, 17-23-17, 17-27a-603, or 57-8-13. See Utah Code 17-27a-103
• Reimbursement report: means a report on the adjustment in total compensation for a claim. See Utah Code 31A-46-102
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Retail pharmacy: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Sale: means a prescription drug or prescription device claim covered by a health benefit plan. See Utah Code 31A-46-102
• Sanitary sewer authority: means the department, agency, or public entity with responsibility to review and approve the feasibility of sanitary sewer services or onsite wastewater systems. See Utah Code 17-27a-103
• Signature: includes a name, mark, or sign written with the intent to authenticate an instrument or writing. See Utah Code 68-3-12.5
• 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
• State agency: means a department, division, board, council, committee, institution, office, bureau, or other similar administrative unit of the executive branch of state government. See Utah Code 67-27-102
• State executive branch agency: includes an agency under the authority of the governor, lieutenant governor, state treasurer, state auditor, or attorney general. See Utah Code 67-26-102
• State official: means :
       (3)(a) a member of the Legislature;
       (3)(b) the governor;
       (3)(c) the lieutenant governor;
       (3)(d) the state auditor;
       (3)(e) the state treasurer; and
       (3)(f) the attorney general. See Utah Code 67-24-102
• Statute: A law passed by a legislature.
• Subdivision: includes :
            (73)(b)(i) the division or development of land, whether by deed, metes and bounds description, devise and testacy, map, plat, or other recorded instrument, regardless of whether the division includes all or a portion of a parcel or lot; and
            (73)(b)(ii) except as provided in Subsection (73)(c), divisions of land for residential and nonresidential uses, including land used or to be used for commercial, agricultural, and industrial purposes. See Utah Code 17-27a-103
• Subdivision amendment: means an amendment to a recorded subdivision in accordance with Section 17-27a-608 that:
            (74)(a)(i) vacates all or a portion of the subdivision;
            (74)(a)(ii) alters the outside boundary of the subdivision;
            (74)(a)(iii) changes the number of lots within the subdivision;
            (74)(a)(iv) alters a public right-of-way, a public easement, or public infrastructure within the subdivision; or
            (74)(a)(v) alters a common area or other common amenity within the subdivision. See Utah Code 17-27a-103
• Town: includes , depending on population, a metro township as defined in Section 10-3c-102. See Utah Code 68-3-12.5
• United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
• Writing: includes :
       (48)(a) printing;
       (48)(b) handwriting; and
       (48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5