Section 21.36.520 - [Effective 1/1/2025] Unfair trade practices(a) An insurer providing a health care insurance policy or its pharmacy benefits manager may not(1) interfere with a covered person's right to choose a pharmacy or provider;(2) interfere with a covered person's right of access to a clinician-administered drug;(3) interfere with the right of a pharmacy or pharmacist to participate as a network pharmacy;(4) reimburse a pharmacy or pharmacist an amount less than the amount the pharmacy benefits manager reimburses an affiliate for providing the same pharmacy services, calculated on a per-unit basis using the same generic product identifier or generic code number;(5) impose a reduction in reimbursement for pharmacy services because of the person's choice among pharmacies that have agreed to participate in the plan according to the terms offered by the insurer or its pharmacy benefits manager;(6) use a covered person's pharmacy services data collected under the provision of claims processing services for the purpose of soliciting, marketing, or referring the person to an affiliate of the pharmacy benefits manager;(7) prohibit or limit a pharmacy from mailing, shipping, or delivering drugs to a patient as an ancillary service; however, the insurer or its pharmacy benefits manager(A) is not required to reimburse a delivery fee charged by a pharmacy unless the fee is specified in the contract between the pharmacy benefits manager and the pharmacy;(B) may not require a patient signature as proof of delivery of a mailed or shipped drug if the pharmacy(i) maintains a mailing or shipping log signed by a representative of the pharmacy or keeps a record of each notification of delivery provided by the United States mail or a package delivery service; and(ii) is responsible for the cost of mailing, shipping, or delivering a replacement for a drug that was mailed or shipped but not received by the covered person;(8) prohibit or limit a network pharmacy from informing an insured person of the difference between the out-of-pocket cost to the covered person to purchase a drug, medical device, or supply using the covered person's pharmacy benefits and the pharmacy's usual and customary charge for the drug, medical device, or supply;(9) conduct or participate in spread pricing in the state;(10) assess, charge, or collect a form of remuneration that passes from a pharmacy or a pharmacist in a pharmacy network to the pharmacy benefits manager, including claim processing fees, performance-based fees, network participation fees, or accreditation fees;(11) reverse and resubmit the claim of a pharmacy more than 90 days after the date the claim was first adjudicated, and may not reverse and resubmit the claim of a pharmacy unless the insurer or pharmacy benefits manager (A) provides prior written notification to the pharmacy;(C) first attempts to reconcile the claim with the pharmacy; and(D) provides to the pharmacy, at the time of the reversal and resubmittal, a written description that includes details of and justification for the reversal and resubmittal.(b) A provision of a contract between a pharmacy benefits manager and a pharmacy or pharmacist that is contrary to a requirement of this section is null, void, and unenforceable in this state.(c) A violation of this section or a regulation adopted under this section is an unfair trade practice and subject to penalty under this chapter.(d) For purposes of this section, a violation has occurred each time a prohibited act is committed.(e) Nothing in this section may interfere with or violate a patient's right under AS 08.80.297 to know where the patient may have access to the lowest-cost drugs or the requirement that a patient must receive notice of a change to a pharmacy network, including the addition of a new pharmacy or removal of an existing pharmacy from a pharmacy network.(f) The director may adopt regulations to provide an appeals process for claims adjudicated under this section.(g) In this section,(1) "affiliate" has the meaning given in AS 21.27.975;(2) "clinician-administered drug" has the meaning given in AS 21.27.951(c);(3) "covered person" has the meaning given in AS 21.27.975;(4) "drug" has the meaning given in AS 21.27.975;(5) "insurer" has the meaning given to "health care insurer" in AS 21.54.500;(6) "network pharmacy" has the meaning given in AS 21.27.975;(7) "out-of-pocket cost" means a deductible, coinsurance, copayment, or similar expense owed by a covered person under the terms of the covered person's health care insurance policy;(8) "provider" has the meaning given in AS 21.27.975;(9) "spread pricing" means the method of pricing a drug in which the contracted price for a drug that a pharmacy benefits manager charges a health care insurance policy differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services.Added by SLA 2024, ch. 61,sec. 12, eff. 1/1/2025, app. to an insurance policy or contract, including a contract between a pharmacy benefits manager and a pharmacy or pharmacist, issued, delivered, entered into, renewed, or amended on or after 1/1/2025.