173.73 Consulting pharmacy benefit manager - price verification.

(A) Any entity that provides services as a pharmacy benefit manager relative to the outpatient drug coverage included in a health benefit plan offered to the employees or retirees of a state agency or political subdivision and the eligible dependents of those employees or retirees shall provide drug pricing verification services under section 173.742 of the Revised Code and drug manufacturer payment verification services under section 173.814 of the Revised Code if the entity is selected under section 173.731 of the Revised Code by the department of aging to serve as the Ohio’s best Rx program’s consulting pharmacy benefit manager for purposes of providing the verification services.

(B) Both of the following apply to the entity selected to serve as the Ohio’s best Rx program’s consulting pharmacy benefit manager:

(1) The entity shall provide the drug pricing verification services and drug manufacturer payment verification services without charge, either to the Ohio’s best Rx program or to the state agency or political subdivision for which it provides services as a pharmacy benefit manager.

(2) The entity shall provide the verification services for the entire year for which it is selected to serve as the program’s consulting pharmacy benefit manager, regardless of the duration or termination of its responsibility to the state agency or political subdivision for which it provides services as a pharmacy benefit manager.

(C) If the entity selected to serve as the consulting pharmacy benefit manager fails to provide the program with drug pricing verification services or drug manufacturer payment verification services, or fails to provide for an audit when requested to do so under section 173.732 of the Revised Code, the department may ask the attorney general to bring an action for injunctive relief in any court of competent jurisdiction. On the filing of an appropriate petition in the court, the court shall conduct a hearing on the petition. If it is demonstrated in the proceedings that the pharmacy benefit manager has failed to provide the verification services or has failed to provide for the audit, the court shall grant a temporary or permanent injunction enjoining the pharmacy benefit manager from continuing to fail to provide the verification services or from continuing to fail to provide for the audit.

(D) This section does not impose any duty on the state agency or political subdivision for which an entity provides services as a pharmacy benefit manager.

Effective Date: 07-01-2007