Conditions under which insurer may limit insured’s choice of drug outlets and pharmacies
(1) An insurer may limit the drug outlets or pharmacists from which a person covered under a health insurance policy issued by the insurer is authorized by the insurer to obtain services only if the insurer first provides an opportunity to drug outlets and pharmacists to offer to participate as a provider of services as provided in this section. An insurer to which this section applies must provide notice of the opportunity by mailing a notice to the professional organization representing drug outlets and pharmacists in the service area of the insurer. The notice must be given at least 10 days before the deadline for receiving offers. The notice shall state the following:
(a) The date after which offers will not be considered.
(b) The services to be provided under the policy.
(c) That each offer must contain a statement that the drug outlet or pharmacist is in compliance with the requirements of the State Board of Pharmacy.
(d) The name and address of the person or office designated for receipt of the offers.
(2) The services to which this section applies are the services normally provided by drug outlets and pharmacists, including but not limited to prescription drugs.
(3) A professional organization that has received notice pursuant to subsection (1) of this section shall take reasonable steps to relay the notice to each drug outlet registered with the State Board of Pharmacy that is in the relevant service area.
(4) The following apply to an offer submitted by a drug outlet or pharmacist in response to a notice given under subsection (1) of this section:
(a) The offer must be in writing.
(b) The offer must be submitted to the person or office designated in the notice.
(c) The drug outlet or pharmacist must agree to provide services specified by the insurer.
(5) An insurer to which this section applies may select any drug outlet or pharmacist of its choice on whatever basis the insurer alone determines to be appropriate. Nothing in this section prohibits an insurer from contracting with one or more drug outlets or pharmacists exclusively for services to be provided to its insureds. [1993 c.391 §2]
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