Effective 1-1-2026.
Sec. 11.5. As used in this chapter, "pharmacy benefit management services" means:
(1) negotiating the price of prescription drugs, including negotiating and contracting for direct or indirect rebates, discounts, or other price concessions;
(2) managing any aspect of a prescription drug benefit, including:
(A) the processing and payment of claims for prescription drugs;
(B) arranging alternative access to or funding for prescription drugs;
(C) the performance of drug utilization review;
(D) the processing of drug prior authorization requests;
(E) the adjudication of appeals or grievances related to the prescription drug benefit;
(F) contracting with network pharmacies;
(G) controlling the cost of covered prescription drugs;
(H) managing or providing data relating to the prescription drug benefit;
(I) the provision of services related to the prescription drug benefit; or
(J) creating or updating prescription drug formularies;
(3) the performance of any administrative, managerial, clinical, pricing, financial, reimbursement, data administration or reporting, or billing service; and
(4) any other services specified in a rule adopted by the department.