Section 376.393

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2020   

  376.393.  Pharmacy benefits manager, license required — definitions — complaints, procedure. — 1.  As used in this section, the following terms shall mean:

  (1)  "Health carrier" or "carrier", the same meaning as is ascribed to such term in section 376.1350;

  (2)  "Pharmacy benefits manager", the same meaning as is ascribed to such term in section 376.388.

  2.  No entity subject to the jurisdiction of this state shall act as a pharmacy benefits manager without a license issued by the department.  The department shall establish by rule the application process and license fee for pharmacy benefits managers.

  3.  The department may cause a complaint to be filed with the administrative hearing commission as provided in chapter 621 against any holder of a license issued under this section for:

  (1)  Violation of the laws or regulations of any state or of the United States, where the offense is reasonably related to the qualifications, functions, or duties of a pharmacy benefits^* manager, including, but not limited to, where an essential element of the offense is fraud, dishonesty, or an act of violence, or where the offense involves moral turpitude, or where the offense involves failure to comply with a requirement of this chapter, whether or not sentence or penalty is imposed;

  (2)  Use of fraud, deception, misrepresentation, or bribery for any reason;

  (3)  Obtaining or attempting to obtain any fee, charge, tuition, or other compensation by fraud, deception, or misrepresentation;

  (4)  Incompetence, misconduct, gross negligence, or dishonesty in the performance of the functions or duties of a pharmacy benefits manager or other regulated profession or activity; or

  (5)  Disciplinary action taken against the holder of a license or other right to practice as a pharmacy benefits manager or other regulated profession.

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After the filing of such complaint, the proceedings shall be conducted in accordance with the provisions of chapter 621.  Upon a finding by the administrative hearing commission that grounds provided in this subsection for disciplinary action are met, the department may, singly or in combination, censure or place the person named in the complaint on probation with such terms and conditions as the department deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the license, certificate, or permit.  An individual whose license has been revoked shall wait at least one year from the date of revocation to apply for relicensure.  Relicensure shall be at the discretion of the department.

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(L. 2020 H.B. 1682)

*Word "benefit" appears in original rolls.