(a) A pharmacy benefit manager shall not:

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Terms Used In Hawaii Revised Statutes 487J-7

  • Affiliated: means businesses or persons who have contractual arrangements with, or are subject to the control of, the pharmacy benefit manager. See Hawaii Revised Statutes 487J-1
  • Employee benefit plan: means any plan as defined in title 29 United States Code § 1002(3), as amended. See Hawaii Revised Statutes 487J-1
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Marketing: means making a communication about a product or service that encourages a recipient of the communication to purchase or use the product or service. See Hawaii Revised Statutes 487J-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 487J-1
(1) Use an individual’s health information, or share an individual’s health information with any pharmacy affiliated with or owned, wholly or in part, by the pharmacy benefit manager, for the purpose of marketing, unless:

(A) Use of the individual’s health information is medically necessary to the health and safety of the individual;
(B) Use of the individual’s health information is consistent with regulations of the federal Centers for Medicare and Medicaid, if the plan is governed by those rules; or
(C) The individual has affirmatively opted in, in writing, to use of the information;
(2) Sell or disseminate such information unless the sale or dissemination complies with all federal and state laws and the pharmacy benefit manager has received written approval for such sale or dissemination from the employee benefit plan, health benefits plan, or managed care plan sponsor, and the individual; or
(3) Directly contact an individual by any means, including via electronic delivery, telephonic, SMS text, or direct mail, for the purposes of marketing pharmacy benefit manager-owned pharmacies without the express written permission of the employee benefit plan, health benefits plan, or managed care plan sponsor, and the individual, unless the employee benefit plan, health benefits plan, or managed care plan sponsor first determines that the contact is medically necessary to the health and safety of the individual.
(b) Nothing in this section shall prohibit the use of a patient’s health information that is used in conjunction with an insurer-authorized program to more effectively use prescription drugs to improve the health and safety of the individual.
(c) A pharmacy benefit manager shall provide each individual with an opportunity to affirmatively opt in to the sale or dissemination of their health information prior to entering into any arrangement for the lease, rental, dissemination, or sale of such information to any other entity, or to any subsidiary owned, wholly or in part, by the pharmacy benefit manager; provided that an individual may freely revoke the affirmative opt in at any time.

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