Alaska Statutes: AS 21.27.950. Multi-Source Generic Drug Appeal.

Alaska Statutes. Title 21. Insurance Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers Section 950. Multi-Source Generic Drug Appeal.

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AS 21.27.950. Multi-Source Generic Drug Appeal.

   (a) A pharmacy benefits manager shall establish a process by which a network pharmacy, or a network pharmacy's contracting agent, may appeal the reimbursement for a multi-source generic drug. A pharmacy benefits manager shall resolve an appeal from a network pharmacy within 10 calendar days after the network pharmacy or the contracting agent submits the appeal.
   (b) A network pharmacy, or a network pharmacy's contracting agent, may appeal a reimbursement from a pharmacy benefits manager for a multi-source generic drug if the reimbursement for the drug is less than the amount that the network pharmacy can purchase from two or more of its contracted suppliers.
   (c) A pharmacy benefits manager may grant a network pharmacy's appeal if an equivalent multi-source generic drug is not available at a price at or below the pharmacy benefits manager's list price for purchase from national or regional wholesalers who operate in the state. If an appeal is granted, the pharmacy benefits manager shall adjust the reimbursement of the network pharmacy to equal the network pharmacy acquisition cost for each paid claim included in the appeal.
   (d) If the pharmacy benefits manager denies a network pharmacy's appeal, the pharmacy benefits manager shall provide the network pharmacy with the
        (1) reason for the denial;
        (2) national drug code of an equivalent multi-source generic drug that has been purchased by another network pharmacy located in the state at a price that is equal to or less than the pharmacy benefits manager's list price within seven days after the network pharmacy appeals the claim; and
        (3) name of a pharmaceutical wholesaler who operates in the state in which the drug may be acquired by the challenging network pharmacy.
   (e) A network pharmacy may request a hearing under AS 21.06.170 — 21.06.240 for an adverse decision from a pharmacy benefits manager within 30 calendar days after receiving the decision. The parties may present all relevant information to the director for the director's review.
   (f) The director shall enter an order that
        (1) grants the network pharmacy's appeal and directs the pharmacy benefits manager to make an adjustment to the disputed claim;
        (2) denies the network pharmacy's appeal; or
        (3) directs other actions considered fair and equitable.

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