§ 27-29.1-5 - Participation of independent community pharmacies. - Rhode Island Statutes

SECTION 27-29.1-5

   § 27-29.1-5  Participation of independentcommunity pharmacies. – (a) Any pharmacies licensed in the state of Rhode Island that are not owned orcontrolled, directly or indirectly by an entity that owns pharmacies licensedin two (2) or more jurisdictions other than Rhode Island, which are notparticipating in an insurer's restricted pharmacy network contract shallnevertheless have the right to provide prescription drug services to theinsurer's insureds and be paid by the insurer as if the pharmacy wereparticipating in the insurer's restricted pharmacy network, provided that suchnon-network independent pharmacies agree:

   (1) To accept as the insurer's payments in full the pricerequired of pharmacies in the insurer's restricted pharmacy network;

   (2) To bill to the insured up to and not in excess of anycopayment, coinsurance, deductible, other amount required of an insured by theinsurer, or for other uncovered services;

   (3) To be reimbursed on the same methodological basis,including, but not limited to, capitation or other risk-sharing methodology, asrequired of pharmacies, in the insurer's restricted pharmacy network;

   (4) To participate in the insurer's utilization review andquality assurance programs, including utilization and drug management reportsas required of pharmacies in the carrier's restricted pharmacy network;

   (5) To provide computerized online eligibility determinationsand claims submissions as required of pharmacies in the insurer's restrictedpharmacy network;

   (6) To participate in the insurer's satisfaction surveys andcomplaint resolution programs for its insureds;

   (7) To protect the insurer's proprietary information and aninsured's confidentiality and privacy;

   (8) To abide by the insurer's performance standards withrespect to waiting times, fill rates and inventory management, includingformulary restrictions;

   (9) To comply with the insurer's claims audit provisions; and

   (10) To certify, using audit results or accountantstatements, the fiscal soundness of the non-network pharmacy.

   (b) An insurer may waive any of the aforementioned agreementsin arranging for the provision of pharmaceutical drug benefits to insuredsthrough a non-network pharmacy. An insurer shall not impose any agreements,terms or conditions on any non-network independent community pharmacy, or onany association of pharmacies, which are more restrictive than those requiredof pharmacies in the insurer's restricted pharmacy network. The failure of anon-network pharmacy to abide by the aforementioned agreements may, at theoption of the insurer, serve as the basis for cancellation of the non-networkpharmacy's participation.