Utah Code 31A-46-310. Prohibited actions with respect to a federally qualified health center
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(1) As used in this section, “federally qualified health center”:
Terms Used In Utah Code 31A-46-310
- Contract: A legal written agreement that becomes binding when signed.
- Dispense: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
- Drug: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
- Insurer: means the same as that term is defined in Section 31A-22-636. See Utah Code 31A-46-102
- Medicaid program: means the same as that term is defined in Section 26B-3-101. See Utah Code 31A-46-102
- Pharmacy: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
- Pharmacy service: means a product, good, or service provided to an individual by a pharmacy or pharmacist. See Utah Code 31A-46-102
(1)(a) means the same as that term is defined in 42 U.S.C. § 1395x(aa)(4); and
(1)(b) includes the pharmacy or pharmacies that are operated by or contract with a federally qualified health center described in Subsection (1)(a) to dispense drugs purchased through the federally qualified health center.
(2) This section applies to a contract entered into or renewed on or after January 1, 2022, between an insurer and a pharmacy described in Subsection (1)(b).
(3) An insurer may not vary the amount that the insurer reimburses to a federally qualified health center for a drug on the basis of whether:
(3)(a) the drug is a 340B drug; or
(3)(b) the pharmacy is a 340B entity.
(4) Subsection (3) does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.
(5) An insurer or an insurer’s pharmacy service entity may not:
(5)(a) on the basis that a federally qualified health center participates, directly or through a contractual arrangement, in the 340B drug discount program:
(5)(a)(i) assess a fee, charge-back, or other adjustment on a federally qualified health center;
(5)(a)(ii) restrict access to the insurer’s pharmacy network;
(5)(a)(iii) require the federally qualified health center to enter into a contract with a specific pharmacy to participate in the insurer’s pharmacy network;
(5)(a)(iv) create a restriction or an additional charge on a patient who chooses to receive drugs from a federally qualified health center; or
(5)(a)(v) create any additional requirements or restrictions on the federally qualified health center; or
(5)(b) require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program.