Terms Used In Hawaii Revised Statutes > Chapter 431S - Pharmacy Benefit Managers

• 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.
• Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• 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}
• Commissioner: means the insurance commissioner. See Hawaii Revised Statutes 431S-1
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• county: includes the city and county of Honolulu. See Hawaii Revised Statutes 1-22
• Covered entity: means :

  (1) A health benefits plan regulated under chapter 87A; health insurer regulated under article 10A of chapter 431; mutual benefit society regulated under article 1 of chapter 432; or health maintenance organization regulated under chapter 432D; provided that a "covered entity" under this paragraph shall not include a health maintenance organization regulated under chapter 432D that owns or manages its own pharmacies;

  (2) A health program administered by the State in the capacity of a provider of health coverage; or

  (3) An employer, labor union, or other group of persons organized in the State that provides health coverage to covered persons employed or residing in the State. See Hawaii Revised Statutes 431S-1

• Dependent: A person dependent for support upon another.
• Enforcement officer: means any person employed and authorized by the commission to investigate any matter on behalf of the commission. See Hawaii Revised Statutes 269-1
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Fraud: Intentional deception resulting in injury to another.
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: means an individual, partnership, corporation, organization, or other business entity. See Hawaii Revised Statutes 431S-1
• Pharmacy benefit management: means :

  (1) Any of the following services provided with regard to the administration of pharmacy benefits:

  (A) Mail service pharmacy;

  (B) Claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to covered persons;

  (C) Clinical formulary development and management services;

  (D) Rebate contracting and administration;

  (E) Certain patient compliance, therapeutic intervention, and generic substitution programs; or

  (F) Disease management programs involving prescription drug utilization;

  (2) The procurement of prescription drugs by a pharmacy benefit manager at a negotiated rate for dispensation to covered persons in the State; or

  (3) The administration or management of prescription drug benefits provided by a covered entity for the benefit of covered persons. See Hawaii Revised Statutes 431S-1

• Pharmacy benefit manager: means any person that performs pharmacy benefit management, including but not limited to a person or entity in a contractual or employment relationship with a pharmacy benefit manager to perform pharmacy benefit management for a covered entity. See Hawaii Revised Statutes 431S-1
• Prescription drug benefit plan: means a health insurance plan offered by a covered entity that includes coverage for prescription drugs. See Hawaii Revised Statutes 431S-1
• Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
• Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
• Service of process: The service of writs or summonses to the appropriate party.