ownership interest in the pharmacy benefits manager or a
corporate affiliate of the pharmacy benefits manager.
(b) A pharmacy benefits manager may not require that a
beneficiary use the services of a specific pharmacy for a
specialty drug.
(c) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection:
"Medical assistance managed care organization" means a
Medicaid managed care organization as defined in section 1903(m)
(1)(a) of the Social Security Act (Public Law 74-271, 42 U.S.C.
ยง 1396b(m)(1)(A)) that is a party to a Medicaid managed care
contract with the department.
"Pharmacy benefits management" means any of the following:
(1) Procurement of prescription drugs at a negotiated
contracted rate for distribution within this Commonwealth to
covered individuals.
(2) Administration or management of prescription drug
benefits provided by a covered entity for the benefit of covered
individuals.
(3) Administration of pharmacy benefits, including:
(i) Operating a mail-service pharmacy.
(ii) Claims processing.
(iii) Managing a retail pharmacy network management.
(iv) Paying claims to pharmacies for prescription drugs
dispensed to covered individuals via retail, specialty or mail-
order pharmacy.
(v) Developing and managing a clinical formulary,
utilization management and quality assurance programs.
(vi) Rebate contracting and administration.
(vii) Managing a patient compliance, therapeutic
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