the actual amount paid by the pharmacy benefits manager to a
pharmacy for dispensing an outpatient covered drug or medical
supply item, including, at a minimum, the ingredient cost and
dispensing fee and any other administrative fees.
(c) A medical assistance managed care organization that
assigns financial responsibility for determining the dispensing
pharmacy payment methodology, including the ingredient cost and
dispensing fee, shall upon request disclose to the department
all financial terms and payment arrangements that apply between
the medical assistance managed care organization and the
pharmacy benefits manager annually and within ten days of any
changes to the financial terms and payment arrangements. For the
purposes of this act, a pharmacy benefits manager which
contracts with a medical assistance managed care organization
shall maintain records sufficient to provide information for
pharmaceuticals dispensed and paid for by medical assistance to
the department, including the information required under Chapter
7 of the act of November 21, 2016 (P.L.1318, No.169), known as
the "Pharmacy Audit Integrity and Transparency Act."
(d) A medical assistance managed care organization shall
establish an appeals process for pharmacies to utilize for
suspected violations of this section.
(e) Any information disclosed or produced by a pharmacy
benefits manager or a medical assistance managed care
organization to the department under this section shall not be
subject to the act of February 14, 2008 (P.L.6, No.3), known as
the "Right-to-Know Law."
(f) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection:
"Pharmacy benefits management" means any of the following:
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