Maine Revised Statutes Title 24-A Sec. 4347 – Definitions
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4347
- Average wholesale price: means the average wholesale price of a prescription drug as identified by a national drug pricing source selected by a health insurer. See Maine Revised Statutes Title 24-A Sec. 4347
- Compensation: means any direct or indirect financial benefit, including, but not limited to, rebates, discounts, credits, fees, grants, charge?backs or other payments or benefits of any kind. See Maine Revised Statutes Title 24-A Sec. 4347
- Contract: A legal written agreement that becomes binding when signed.
- Covered person: includes the authorized representative of a covered person. See Maine Revised Statutes Title 24-A Sec. 4347
- Dispensing fee: means the professional fee incurred at the point of sale or service that pays for pharmacy costs, in excess of ingredient cost, associated with ensuring that possession of the appropriate prescription drug is transferred to a covered person. See Maine Revised Statutes Title 24-A Sec. 4347
- Formulary: means a list of prescription drugs covered by a health plan and any tier levels applicable to a prescription drug. See Maine Revised Statutes Title 24-A Sec. 4347
- Generic drug: includes a biosimilar product. See Maine Revised Statutes Title 24-A Sec. 4347
- Ingredient cost: means the actual amount paid to a pharmacy provider by a carrier or the carrier's pharmacy benefits manager for a prescription drug, not including the dispensing fee or cost?sharing amount. See Maine Revised Statutes Title 24-A Sec. 4347
- Mail order pharmacy: means a pharmacy whose primary business is to receive prescriptions by mail, by fax or through electronic submissions and to dispense medication to covered persons through the use of the United States mail or other common or contract carrier services and that provides any consultation with patients electronically rather than face to face. See Maine Revised Statutes Title 24-A Sec. 4347
- Maximum allowable cost: means the maximum amount a health insurer will pay for a generic drug or brand?name drug that has at least one generic alternative available. See Maine Revised Statutes Title 24-A Sec. 4347
- Network pharmacy: means a licensed retail pharmacy or other pharmacy provider that contracts with a pharmacy benefits manager. See Maine Revised Statutes Title 24-A Sec. 4347
- Pharmacy: means an established location, either physical or electronic, that is licensed by the State and that has entered into a network pharmacy contract with a pharmacy benefits manager or carrier. See Maine Revised Statutes Title 24-A Sec. 4347
- Pharmacy and therapeutics committee: means a committee, board or equivalent body established by a carrier to develop and maintain formularies. See Maine Revised Statutes Title 24-A Sec. 4347
- Pharmacy benefits manager: means a person, business or other entity that, pursuant to a contract or under an employment relationship with a carrier, a self?insurance plan or other 3rd?party payer, either directly or through an intermediary, manages the prescription drug coverage provided by the carrier, self?insurance plan or other 3rd?party payer, including, but not limited to, processing and paying claims for prescription drugs, performing drug utilization review, processing drug prior authorization requests, adjudicating appeals or grievances related to prescription drug coverage, contracting with network pharmacies and controlling the cost of covered prescription drugs. See Maine Revised Statutes Title 24-A Sec. 4347
- Pharmacy provider: means a retail pharmacy, mail order pharmacy or licensed pharmacist. See Maine Revised Statutes Title 24-A Sec. 4347
- Retail pharmacy: means a chain pharmacy, a supermarket pharmacy, a mass merchandiser pharmacy, an independent pharmacy or a network of independent pharmacies that is licensed as a pharmacy by this State and that dispenses medications to the public. See Maine Revised Statutes Title 24-A Sec. 4347
- United States: includes territories and the District of Columbia. See Maine Revised Statutes Title 1 Sec. 72
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]