As used in the Pharmacy Benefits Manager Regulation Act:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

A. “maximum allowable cost” means the maximum amount that a pharmacy benefits manager will reimburse a pharmacy for the cost of a generic drug;

B. “maximum allowable cost list” means a searchable, electronic and internet-based listing of drugs used by a pharmacy benefits manager setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist is made;

C. “obsolete” means a product that is listed in national drug pricing compendia but is no longer available to be dispensed based on the expiration date of the last lot manufactured;

D. “pharmacist” means an individual licensed as a pharmacist by the board of pharmacy;

E. “pharmacy” means a licensed place of business where drugs are compounded or dispensed and pharmacist services are provided;

F. “pharmacy benefits management” means a service provided to or conducted by a health plan as defined in Section 59A-16-21.1 N.M. Stat. Ann. or health insurer that involves:

(1)     prescription drug claim administration;

(2)     pharmacy network management;

(3)     negotiation and administration of prescription drug discounts, rebates and other benefits;

(4)     design, administration or management of prescription drug benefits; (5)     formulary management;

(6)     payment of claims to pharmacies for dispensing prescription drugs;

(7)     negotiation or administration of contracts relating to pharmacy operations or prescription benefits; or

(8)     any other service determined by the superintendent as specified by rule to be a pharmacy benefits management activity;

G. “pharmacy benefits manager” means an entity that provides pharmacy benefits management services;

H. “pharmacy benefits manager affiliate” means a pharmacy or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by or is under common ownership or control with a pharmacy benefits manager;

I. “pharmacy services administrative organization” means an entity that contracts with a pharmacy or pharmacist to act as the pharmacy or pharmacist’s agent with respect to matters involving a pharmacy benefits manager or third-party payor, including negotiating, executing or administering contracts with the pharmacy benefits manager or third-party payor; and

J. “superintendent” means the superintendent of insurance.