(a) An otherwise qualified retail community pharmacy registered to do business in this State that requests to enter into a contractual retail pharmacy network agreement accepting the standard terms, conditions, formularies, or requirements relating to dispensing fees, payments, reimbursement amounts, or other pharmacy services shall be considered part of a pharmacy benefit manager‘s retail pharmacy network for purposes of a beneficiary‘s right to choose where to purchase covered prescription drugs under section beneficiary choice; mail order opt out” class=”unlinked-ref” datatype=”S” sessionyear=”2022″ statecd=”HI”>431R-3.

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Terms Used In Hawaii Revised Statutes 431R-2

  • 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.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • beneficiary: means a person who is a member, subscriber, enrollee, or dependent of a member, subscriber, or enrollee of or otherwise covered under a prescription drug benefit plan. See Hawaii Revised Statutes 431R-1
  • Pharmacy benefit manager: means any person, business, or entity that performs pharmacy benefit management, including but not limited to a person or entity under contract with a pharmacy benefit manager to perform pharmacy benefit management on behalf of a managed care company, nonprofit hospital or medical service organization, insurance company, third-party payor, or health program administered by the State. See Hawaii Revised Statutes 431R-1
  • Prescription drug benefit plan: means an accident and sickness insurance plan or health benefits plan that includes coverage for prescription drugs. See Hawaii Revised Statutes 431R-1
  • Retail community pharmacy: means a pharmacy, permitted by the board of pharmacy pursuant to § 461-14, that is open to the public, dispenses prescription drugs to the general public, and makes available face-to-face consultations between licensed pharmacists and the general public to whom prescription drugs are dispensed. See Hawaii Revised Statutes 431R-1
(b) It shall be a violation of this section for a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager to refuse to accept an otherwise qualified retail community pharmacy as part of a pharmacy benefit manager’s retail pharmacy network.
(c) A contractual retail pharmacy network agreement entered into under this section shall be renewed annually, unless agreed to by the parties. If a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager who has entered into a contractual retail pharmacy network agreement with a retail community pharmacy considers such retail community pharmacy no longer otherwise qualified, the prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager may appeal the retail community pharmacy’s qualifications with the insurance commissioner.
(d) The insurance commissioner shall determine the standards and requirements necessary for a retail community pharmacy to be deemed “otherwise qualified” for purposes of this section.