(a) The insurance commissioner may assess a fine of up to $10,000 for each violation by a pharmacy benefit manager or prescription drug benefit plan provider who is in violation of section 431R-2 or beneficiary choice; mail order opt out” class=”unlinked-ref” datatype=”S” sessionyear=”2022″ statecd=”HI”>431R-3. In addition, the insurance commissioner may order the pharmacy benefit manager to take specific affirmative corrective action or make restitution.

Terms Used In Hawaii Revised Statutes 431R-5

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • 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
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • 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
  • Prescription drug benefit plan provider: means a person who provides prescription drug coverage as part of an accident and health or sickness insurance contract or other type of health insurance or benefits plan that is offered by the person and is subject to regulation under article 10A of chapter 431, chapter 432, or chapter 432D. See Hawaii Revised Statutes 431R-1
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
(b) Failure of a pharmacy benefit manager to comply with a previously agreed upon contractual retail pharmacy network agreement pursuant to section 431R-2 or beneficiary choice; mail order opt out” class=”unlinked-ref” datatype=”S” sessionyear=”2022″ statecd=”HI”>431R-3 shall be an unfair or deceptive act or practice as provided in section 431:13-102.
(c) A pharmacy benefit manager or prescription drug benefit plan provider may appeal any decision made by the insurance commissioner in accordance with chapter 91.
(d) Every person and its officers, employees, and representatives subject to investigation or examination by the commissioner under this chapter shall produce and make freely accessible to the commissioner the accounts, records, documents, and files in the person’s possession or control relating to the subject of the investigation or examination and shall otherwise facilitate the investigation or examination.
(e) Every person and its officers, employees, and representatives subject to investigation or examination by the commissioner under this chapter shall issue a written response no later than fifteen working days after receiving a written inquiry from the commissioner regarding a claim or complaint. The response shall be more than an acknowledgment that the commissioner’s communication has been received and shall adequately address the concerns stated in the communication.