Sec. 38a-471. (Formerly Sec. 38-174o). Third party prescription programs. Notice of cancellation. Applicability of section.
Sec. 38a-471. (Formerly Sec. 38-174o). Third party prescription programs.
Notice of cancellation. Applicability of section. (a) As used in this section, a "third
party prescription program" means a system of providing for reimbursement for the
cost of drugs or pharmaceutical services under a contractual arrangement or agreement
with a provider of such drugs or services. Such programs shall include, but not be limited
to, employee benefit plans under which a consumer receives prescription drugs or pharmaceutical services and such drugs or services are paid for in part by an agent of the
consumer's employer or others. An "administrator" means the program administrator
of a third party prescription program.
(b) Any agreement or contract entered into in this state between an administrator
and a pharmacy shall include a statement of the method and amount of reimbursement
to the pharmacy for drugs or services provided to persons enrolled in the program, and
the frequency of payment by the administrator to the pharmacy for such drugs or services.
(c) (1) Each administrator of a program shall notify all pharmacies enrolled in such
program of any cancellation of coverage or benefits of any group enrolled in the program
at least thirty days prior to the effective date of such cancellation or within ten business
days following the date on which he receives notice of a cancellation, if he receives
such notice less than forty days prior to its effective date.
(2) Each employer shall give written notice to all persons enrolled in such program
of the cancellation of the plan and written notice to any person whose enrollment is
terminated. Such notice shall be given as soon as is practicable but in no case later than
thirty days after cancellation or termination. Such notice shall include a demand for the
return of any plan identification cards such persons may have been issued by reason of
their enrollment in such program.
(3) Any person who uses a program identification card to obtain drugs or services
from a pharmacy after having received notice of the cancellation of his program shall
be liable to the administrator for all moneys paid by the administrator for any drugs or
services obtained by the illegal use of such card.
(d) (1) No administrator shall deny payment to any pharmacy for drugs or services
which were provided as the result of the fraudulent or illegal use of an identification
card by any person to whom an identification card was issued, unless the pharmacy was
notified of the cancellation of such card.
(2) No administrator shall withhold payments for uncontested claims to any pharmacy beyond the time period specified in the payment schedule provisions of the
agreement.
(e) Each administrator shall mail to any pharmacist, upon written request, a copy
of each contract or agreement form in use in this state between such administrator and
a pharmacy.
(f) No administrator shall prohibit a pharmacy from enrolling in a program except
for cause, including, but not limited to, previous fraudulent use of program identification
cards.
(g) The provisions of this section shall not apply to the providing of drugs or services
under the provisions of Title XIX of the Social Security Act.
(P.A. 81-455, S. 1-8.)
History: Sec. 38-174o transferred to Sec. 38a-471 in 1991.