Alaska Statutes 21.27.955 – Definitions

In Alaska Stat. § 21.27.901 – 21.27.955,

(1) “audit” means an official examination and verification of accounts and records;

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Terms Used In Alaska Statutes 21.27.955

Contract: A legal written agreement that becomes binding when signed.
person: includes a corporation, company, partnership, firm, association, organization, business trust, or society, as well as a natural person. See Alaska Statutes 01.10.060

(2) “claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device;

(3) “extrapolation” means the practice of inferring a frequency or dollar amount of overpayments, underpayments, invalid claims, or other errors on any portion of claims submitted, based on the frequency or dollar amount of overpayments, underpayments, invalid claims, or other errors actually measured in a sample of claims;

(4) “list” means the list of multi-source generic drugs for which a predetermined reimbursement amount has been established such as a maximum allowable cost or maximum allowable cost list or any other list of prices used by a pharmacy benefits manager;

(5) “multi-source generic drug” means any covered outpatient prescription drug that the United States Food and Drug Administration has determined is pharmaceutically equivalent or bioequivalent to the originator or name brand drug and for which there are at least two drug products that are rated as therapeutically equivalent under the United States Food and Drug Administration’s most recent publication of “Approved Drug Products with Therapeutic Equivalence Evaluations”;

(6) “network pharmacy” means a pharmacy that provides covered health care services or supplies to an insured or a member under a contract with a network plan to act as a participating provider;

(7) “pharmacy” has the meaning given in Alaska Stat. § 08.80.480;

(8) “pharmacy acquisition cost” means the amount that a pharmaceutical wholesaler or distributor charges for a pharmaceutical product as listed on the pharmacy’s invoice;

(9) “pharmacy benefits manager” means a person that contracts with a pharmacy on behalf of an insurer to process claims or pay pharmacies for prescription drugs or medical devices and supplies or provide network management for pharmacies;

(10) “recoupment” means the amount that a pharmacy must remit to a pharmacy benefits manager when the pharmacy benefits manager has determined that an overpayment to the pharmacy has occurred.

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