"Covered entity." A member, participant, enrollee, contract
holder or policy holder providing pharmacy benefits to a covered
individual under a health coverage plan pursuant to a contract
administered by a pharmacy benefit manager.
"Department." The Department of Health of the Commonwealth.
"Maximum allowable cost." The maximum amount that a pharmacy
benefits manager will reimburse a pharmacy for the cost of a
drug or a medical product or device.
"Maximum allowable cost list." A list of drugs, medical
products or devices, or both, for which a maximum allowable cost
has been established by a pharmacy benefits manager.
"Multiple source drug." A covered outpatient drug for which
there is at least one other drug product that is rated as
therapeutically equivalent under the Food and Drug
Administration's most recent publication of "Approved Drug
Products with Therapeutic Equivalence Evaluations."
"Network." A pharmacy or group of pharmacies that agree to
provide prescription services to covered individuals on behalf
of a covered entity or group of covered entities in exchange for
payment for its services by a pharmacy benefits manager or
pharmacy services administration organization. The term includes
a pharmacy that generally dispenses outpatient prescriptions to
covered individuals or dispenses particular types of
prescriptions, provides pharmacy services to particular types of
covered individuals or dispenses prescriptions in particular
health care settings, including networks of specialty,
institutional or long-term care facilities.
"Pharmacy." As defined in section 2(12) of the act of
September 27, 1961 (P.L.1700, No.699), known as the Pharmacy
Act.
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