Terms Used In Virginia Code > Title 38.2 > Chapter 34 > Article 9 - Pharmacy Benefits Managers.

• Aggregate retained rebate percentage: means the sum total dollar amount of a pharmacy benefits manager's retained rebates relating to all carrier clients of such pharmacy benefits manager divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager relating to all such clients. See Virginia Code 38.2-3465
• Bureau of Insurance: means the division of the Commission established to administer the insurance laws of the Commonwealth. See Virginia Code 38.2-100
• Claim: means a request from a pharmacy or pharmacist to be reimbursed for the cost of administering, filling, or refilling a prescription for a drug or for providing a medical supply or device. See Virginia Code 38.2-3465
• Claims processing services: means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include (i) receiving payments for pharmacist services, (ii) making payments to pharmacists or pharmacies for pharmacist services, or (iii) both receiving and making payments. See Virginia Code 38.2-3465
• Commission: means the State Corporation Commission. See Virginia Code 38.2-100
• Company: means any association, aggregate of individuals, business, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Virginia Code 38.2-100
• Contract: A legal written agreement that becomes binding when signed.
• Contract pharmacy: means a pharmacy operating under contract with a 340B-covered entity to provide dispensing services to the 340B-covered entity, as described in 75 Fed. See Virginia Code 38.2-3465
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Covered entity: means an entity described in § 340B(a)(4) of the federal Public Health Service Act, Virginia Code 38.2-3465
• Covered individual: means an individual receiving prescription medication coverage or reimbursement provided by a pharmacy benefits manager or a carrier under a health benefit plan. See Virginia Code 38.2-3465
• in writing: include any representation of words, letters, symbols, numbers, or figures, whether (i) printed or inscribed on a tangible medium or (ii) stored in an electronic or other medium and retrievable in a perceivable form and whether an electronic signature authorized by Virginia Code 1-257
• Includes: means includes, but not limited to. See Virginia Code 1-218
• Mail order pharmacy: means a pharmacy whose primary business is to receive prescriptions by mail or through electronic submissions and to dispense medication to covered individuals through the use of the United States mail or other common or contract carrier services and that provides any consultation with covered individuals electronically rather than face-to-face. See Virginia Code 38.2-3465
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• PBM: means an entity that performs pharmacy benefits management. See Virginia Code 38.2-3465
• Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Virginia Code 38.2-100
• Pharmacy benefits management: means the administration or management of prescription drug benefits provided by a carrier for the benefit of covered individuals. See Virginia Code 38.2-3465
• Pharmacy benefits manager: includes an entity acting for a PBM in a contractual relationship in the performance of pharmacy benefits management for a carrier, nonprofit hospital, or third-party payor under a health program administered by the Commonwealth. See Virginia Code 38.2-3465
• Pharmacy benefits manager affiliate: means a business, 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 interest or control with a pharmacy benefits manager. See Virginia Code 38.2-3465
• Process: includes subpoenas, the summons and complaint in a civil action, and process in statutory actions. See Virginia Code 1-237
• Rebate: means a discount or other price concession, including without limitation incentives, disbursements, and reasonable estimates of a volume-based discount, or a payment that is (i) based on utilization of a prescription drug and (ii) paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefits manager, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy. See Virginia Code 38.2-3465
• Service of process: The service of writs or summonses to the appropriate party.
• Spread pricing: means the model of prescription drug pricing in which the pharmacy benefits manager charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services. See Virginia Code 38.2-3465
• State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
• Subpoena: A command to a witness to appear and give testimony.
• United States: includes the 50 states, the District of Columbia the Commonwealth of Puerto Rico, Guam, the Northern Mariana Islands and the United States Virgin Islands. See Virginia Code 1-255