Utah Code 49-20-421. Prescription discount program
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(1) As used in this section:
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
(1)(a) “Discount program” means the prescription discount program created by this section.
(1)(b) “Epinephrine auto-injector” means the same as that term is defined in Section 26B-4-401.
(1)(c) “Insulin” means a prescription drug that contains insulin.
(1)(d) “Participant” means a resident of Utah who:
(1)(d)(i) has a prescription or standing prescription for a qualified prescription;
(1)(d)(ii) does not receive health coverage under the program; and
(1)(d)(iii) enrolls in the discount program.
(1)(e) “Prescription drug” means the same as that term is defined in Section 58-17b-102.
(1)(f) “Qualified prescription” means a prescription drug, including insulin and epinephrine auto-injectors, that the program has determined:
(1)(f)(i) treats a serious, prevalent, and ongoing condition;
(1)(f)(ii) does not have a generic substitute;
(1)(f)(iii) qualifies for a substantial rebate; and
(1)(f)(iv) would not result in financial losses to the state risk pool if sold as part of the discount program.
(1)(g) “Rebate” means the same as that term is defined in Section 31A-46-102.
(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:
(3)(a) provide a participant with a card or electronic document that identifies the participant as eligible for the discount on a qualified prescription;
(3)(b) provide a participant with information about pharmacies that will honor the discount; and
(3)(c) provide a participant with instructions to pursue a reimbursement of the purchase price from the participant’s health insurer.
(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:
(5)(a) the name of the drug; and
(5)(b) the primary condition the drug treats.