(a) If a retail community pharmacy enters into a contractual retail pharmacy network agreement pursuant to section 431R-2,a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager shall permit each beneficiary, at the beneficiary‘s option, to fill any covered prescription that may be obtained by mail order at any retail community pharmacy of the beneficiary’s choice within the pharmacy benefit manager’s retail pharmacy network.
Terms Used In Hawaii Revised Statutes 431R-3
Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
beneficiary: means a person who is a member, subscriber, enrollee, or dependent of a member, subscriber, or enrollee of or otherwise covered under a prescription drug benefit plan. See Hawaii Revised Statutes 431R-1
Pharmacy benefit manager: means any person, business, or entity that performs pharmacy benefit management, including but not limited to a person or entity under contract with a pharmacy benefit manager to perform pharmacy benefit management on behalf of a managed care company, nonprofit hospital or medical service organization, insurance company, third-party payor, or health program administered by the State. See Hawaii Revised Statutes 431R-1
Prescription drug benefit plan: means an accident and sickness insurance plan or health benefits plan that includes coverage for prescription drugs. See Hawaii Revised Statutes 431R-1
Retail community pharmacy: means a pharmacy, permitted by the board of pharmacy pursuant to § 461-14, that is open to the public, dispenses prescription drugs to the general public, and makes available face-to-face consultations between licensed pharmacists and the general public to whom prescription drugs are dispensed. See Hawaii Revised Statutes 431R-1
(b) A prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager who has entered into a contractual retail pharmacy network agreement with a retail community pharmacy shall not:
(1) Require a beneficiary to exclusively obtain any prescription from a mail order pharmacy;(2) Impose upon a beneficiary utilizing the retail community pharmacy a copayment, fee, or other condition not imposed upon beneficiaries electing to utilize a mail order pharmacy;(3) Subject any prescription dispensed by a retail community pharmacy to a beneficiary to a minimum or maximum quantity limit, length of script, restriction on refills, or requirement to obtain refills not imposed upon a mail order pharmacy;(4) Require a beneficiary in whole or in part to pay for any prescription dispensed by a retail community pharmacy and seek reimbursement if the beneficiary is not required to pay for and seek reimbursement in the same manner for a prescription dispensed by a mail order pharmacy;(5) Subject a beneficiary to any administrative requirement to use a retail community pharmacy that is not imposed upon the use of a mail order pharmacy; or(6) Impose any other term, condition, or requirement pertaining to the use of the services of a retail community pharmacy that materially and unreasonably interferes with or impairs the right of a beneficiary to obtain prescriptions from a retail community pharmacy of the beneficiary’s choice.
