(1)The pharmacy shall contract with the Authority, or its designated entity, and must be licensed with their state Board of Pharmacy to be a pharmacy provider for the OPDP.
(2)The pharmacy provider must sign a pharmacy provider contract and comply with all applicable state and federal laws, regulations, rules, and the terms and conditions of the contract. The contract authorizes the pharmacy provider to serve members in the OPDP and outlines program compliance requirements.
(3)A contract may be issued to a qualified pharmacy provider upon:
(a)Completion and signature of the contract by the pharmacy provider or a person authorized by the pharmacy provider to bind the organization;
(b)Verification of Pharmacy licensing with their State Board of Pharmacy; and
(c)Approval of the contract by the Authority or its designated entity.
(4)To contract for the OPDP, the pharmacy provider must:
(a)Accept the program price in effect on the date of the transaction as established by the Administrator or designated entity including but not limited to dispensing fees which may be charged to the member;
(b)Maintain sufficient documentation of transactions to resolve disagreements with the member or participating program about the amount charged for the prescription drugs;
(c)Reimburse the member or participating program directly for overcharges as determined by program price in effect on the date of the transaction;
(d)Provide access to records and data required by the designated entity to administer claims, reimbursement, and other tasks as necessary for OPDP claims processing; and
(e)Not charge members for costs incurred by the pharmacy provider for the electronic transmittal of the program price from the Authority to the pharmacy.
(5)Pharmacy providers may advertise participation in the OPDP, provided that:
(a)Advertising or marketing materials must be accurate and not misleading or confusing to members or the public about participation in the OPDP or the savings offered by the pharmacy provider.
(b)The pharmacy provider must cease all advertisements pertaining to participation in the program if the Authority suspends or terminates the contract.
(6)The Administrator or designated entity shall, at its discretion, suspend or remove a pharmacy provider from the OPDP if the pharmacy provider loses licensure or fails to comply with applicable state and federal laws, rules, and regulations, and the terms and conditions of the contract.
Rule 431-121-2010 — Pharmacy Providers,