A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers a prescription drug benefit shall reimburse community-based pharmacy providers as follows: (1) for the ingredient cost of a prescription drug at a value that is at least equal to the national average drug acquisition cost for the prescription drug at the time that the prescription drug is administered or dispensed, or if data for the national average drug acquisition cost is unavailable, the wholesale acquisition cost of the prescription drug; and (2) a professional dispensing fee. B. The professional dispensing fee reimbursed to community-based pharmacy providers shall be no less than the professional dispensing fee reimbursed to community-based pharmacy providers for covered outpatient drugs in the medicaid fee- for-service program. C. For the purposes of this section: (1) "community-based pharmacy provider" means a pharmacy that is: (a) open to the public for prescriptions to be filled, regardless of the facility or practice where the prescription was written; (b) located in the state or near the state border, if the border town is a primary source of prescription drugs for medicaid recipients residing in the border area; and (c) not: 1) government-owned; 2) hospital-owned; 3) owned by a corporation that owns hospitals; 4) an extension of a medical practice or special facility; 5) owned by a corporate chain of pharmacies with stores outside of the state; or 6) a mail-order pharmacy; (2) "ingredient cost" means the actual amount paid to a community-based pharmacy provider for a prescription drug, not including the professional dispensing fee or cost sharing; (3) "medicaid" means the medical assistance program established pursuant to Title 19 of the federal Social Security Act and regulations issued pursuant to that act; (4) "national average drug acquisition cost" means the national average of prices at which pharmacies purchase a prescription drug from manufacturers or wholesalers; and (5) "wholesale acquisition cost" means a manufacturer's list price for a prescription drug sold to wholesalers in the United States, not including discounts, rebates or reductions in price." History: Laws 2025, ch. 33, § 1.
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