31A-46-310. Prohibited actions with respect to a federally qualified health center.
| (1) |
As used in this section, “federally qualified health center”:
Terms Used In Utah Code 31A-46-310
| (a) |
means the same as that term is defined in 42 U.S.C. § 1395x(aa)(4); and |
| (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:
| (a) |
the drug is a 340B drug; or |
| (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:
| (a) |
on the basis that a federally qualified health center participates, directly or through a contractual arrangement, in the 340B drug discount program:
| (i) |
assess a fee, charge-back, or other adjustment on a federally qualified health center; |
| (ii) |
restrict access to the insurer’s pharmacy network; |
| (iii) |
require the federally qualified health center to enter into a contract with a specific pharmacy to participate in the insurer’s pharmacy network; |
| (iv) |
create a restriction or an additional charge on a patient who chooses to receive drugs from a federally qualified health center; or |
| (v) |
create any additional requirements or restrictions on the federally qualified health center; or |
|
| (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. |
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Enacted by Chapter 317, 2021 General Session
