Terms Used In Utah Code > Title 31A > Chapter 46 > Part 1 - General Provisions

• Administrative fee: means any payment, other than a rebate, that a pharmaceutical manufacturer makes directly or indirectly to a pharmacy benefit manager. See Utah Code 31A-46-102
• Device: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• 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
• Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
• Individual: means a natural person. See Utah Code 31A-1-301
• Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:

  (i)	a policyholder;

  (ii)	a subscriber;

  (iii)

  a member; and

  (iv)

  a beneficiary. See Utah Code 31A-1-301 Insurer: means the same as that term is defined in Section 31A-22-636. See Utah Code 31A-46-102 Participating: means a plan of insurance under which the insured is entitled to receive a dividend representing a share of the surplus of the insurer. See Utah Code 31A-1-301 Person: includes : (a)  an individual; (b)  a partnership; (c)  a corporation; (d)  an incorporated or unincorporated association; (e)  a joint stock company; (f)  a trust; (g)  a limited liability company; (h)  a reciprocal; (i)  a syndicate; or (j)  another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301 Pharmaceutical facility: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102 Pharmaceutical manufacturer: means a pharmaceutical facility that manufactures prescription drugs. See Utah Code 31A-46-102 Pharmacist: means the same as that term is defined in Section 58-17b-102. 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 benefit manager: means a person licensed under this chapter to provide a pharmacy benefits management service. See Utah Code 31A-46-102 Pharmacy benefits management service: means any of the following services provided to a health benefit plan, or to a participant of a health benefit plan: (a)  negotiating the amount to be paid by a health benefit plan for a prescription drug; or (b)  administering or managing a prescription drug benefit provided by the health benefit plan for the benefit of a participant of the health benefit plan, including administering or managing: (i)  an out-of-state mail service pharmacy; (ii)  a specialty pharmacy; (iii)  claims processing; (iv)  payment of a claim; (v)  retail network management; (vi)  clinical formulary development; (vii)  clinical formulary management services; (viii)  rebate contracting; (ix)  rebate administration; (x)  a participant compliance program; (xi)  a therapeutic intervention program; (xii)  a disease management program; or (xiii)  a service that is similar to, or related to, a service described in Subsection (21)(a) or (21)(b)(i) through (xii). See Utah Code 31A-46-102 Pharmacy services administration organization: means an entity that contracts with a pharmacy to assist with third-party payer interactions and administrative services related to third-party payer interactions, including: (a)  contracting with a pharmacy benefit manager on behalf of the pharmacy; and (b)  managing a pharmacy's claims payments from third-party payers. See Utah Code 31A-46-102 Prescription device: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102 Prescription drug: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102 Property: includes both real and personal property. See Utah Code 68-3-12.5 Rebate: means a refund, discount, or other price concession that is paid by a pharmaceutical manufacturer to a pharmacy benefit manager based on a prescription drug's utilization or effectiveness. See Utah Code 31A-46-102 Sale: means a prescription drug or prescription device claim covered by a health benefit plan. See Utah Code 31A-46-102 State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5