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Status: Enacted
Year Enacted: 2014
An MCO shall pay any provider of emergency services that does not have in effect a contract with the contracted Medicaid MCO. The default rate of reimbursement shall be the rate paid under Illinois Medicaid […]
Status: Enacted
Year Enacted: 2017
A pharmacy benefits manager shall be proscribed from prohibiting a pharmacist or pharmacy from providing an insured individual information on the amount of the insured’s cost share for such insured’s prescription drug and the clinical […]
Status: Enacted
Year Enacted: 1997
Services rendered by preferred providers may be compensated either through direct payments to the health care provider or through reimbursement to the insured. PPOs must also pay a reasonable amount of compensation as determined by […]
Status: Enacted
Year Enacted: 2007
The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit […]
Status: Enacted
Year Enacted: 2010
Except as provided in subsection (3), an insured may not be liable to an on-call physician or a hospital-based physician subject to this section for covered services rendered by the on- call physician or hospital-based […]
Status: Enacted
Year Enacted: 1997
Insurers may an insurer may offer preferred provider insurance policies that limit, through the use of provider service contracts, the numbers and types of providers of health care services eligible for payment as preferred providers, […]
Minn. Stat. §§ 151.01; 151.21 – Minnesota
Status: Enacted
Requires a pharmacist to substitute a biological similar drug if a less expensive one is available as long as the patient has not expressly indicated as otherwise.
Status: Enacted
Year Enacted: 2015
Definitions for reference pricing in Montana for Disability Insurance.
Status: Enacted
Year Enacted: 2015
Specifications for a drug before a pharmacy benefit manager places or continues it on a maximum allowable cost list.
Status: Enacted
Year Enacted: 2015
At the time it enters into a contract with a pharmacy and subsequently upon request, a plan sponsor, health insurance issuer, or pharmacy benefit manager shall provide the pharmacy with the sources used to determine […]
Status: Enacted
Year Enacted: 2015
If the final determination is a denial of the pharmacy’s appeal, the pharmacy benefit manager shall state the reason for the denial and provide the national drug code of an equivalent drug that is available […]
Status: Enacted
Year Enacted: 2017
Pharmacists or pharmacies in a network plan on referenced based pricing may decline to provide a brand-namedrug, multisource generic drug, supply, or service if the reference pricing amount is less than the acquisition cost paid […]
N.H. Rev. Stat. Ann. §§ 126-AA:1 through 126-AA:5: Evaluation Report Required: New Hampshire Granite Advantage Health Care Program – New Hampshire
Status: Enacted
Year Enacted: 2018
Requires an outcomes-based evaluation of the Medicaid program to provide accountability, ensure patients are making informed decisions, and that incentives, cost transparency and reference based pricing have been effective.
Status: Enacted
Year Enacted: 1965
Among other powers, the council has the authority to establisy the of schedules of rates, payments, reimbursements, grants and other charges for hospital and health-related services
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