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27-45A-5
Section 27-45A-5 Disclosure of cost share information; discussion and sale of prescription
drug alternatives; prohibited payment practices. (a) A pharmacy or pharmacist may provide
a covered person with information regarding the amount of the covered person's cost share
for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy
benefits manager from discussing any such information or for selling a more affordable alternative
to the covered person if such an alternative is available. (b) A health benefit plan that
covers prescription drugs may not include a provision that requires an enrollee to make a
payment for a prescription drug at the point of sale in an amount that exceeds the lessor
of: (1) the contracted co-payment amount; or (2) the amount an individual would pay for a
prescription if that individual were paying with cash. (c) For purposes of this section,
the following words have the following meanings: (1) COVERED PERSON. Any individual,...
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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall
follow these procedures: (1) The pharmacy contract shall identify and describe in detail the
audit procedures. (2) The entity conducting the on-site audit shall give the pharmacy written
notice at least two weeks before conducting the initial on-site audit for each audit cycle.
If the pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
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27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every
health benefit plan that provides coverage for prescription drugs or devices, or administers
a plan, including, but not limited to, third party administrators for self-insured plans and
state administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds
a card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
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20-2-213
Section 20-2-213 Reporting requirements. (a) Each of the entities designated in subsection
(b) shall report to the department, or to an entity designated by the department, controlled
substances prescription information as designated by regulation pertaining to all Class II,
Class III, Class IV, and Class V controlled substances in such manner as may be prescribed
by the department by regulation. (b) The following entities or practitioners are subject to
the reporting requirements of subsection (a): (1) Licensed pharmacies, not including pharmacies
of general and specialized hospitals, nursing homes, and any other health care facilities
which provide inpatient care, so long as the controlled substance is administered and used
by a patient on the premises of the facility. (2) Mail order pharmacies or pharmacy benefit
programs filling prescriptions for or dispensing controlled substances to residents of this
state. (3) Licensed physicians, dentists, podiatrists, or optometrists who...
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27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and
may be cited as the "Patient Right to Know Act." (b) As used in this section,
unless the context clearly indicates otherwise, the following words shall have the following
meanings: (1) ENROLLEE. A person who purchases individual health care coverage or an employer
who purchases a group health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist,
optometrist, psychologist, clinical social worker, advanced nurse practitioner, registered
optician, licensed professional counselor, physical therapist, and chiropractor. (c)(1) All
persons, firms, corporations, associations, health maintenance organizations, health insurance
services, or preferred provider organizations, any employer-sponsored health benefit plan,
or any similar organization or entity, providing health, accident, or dental insurance coverage,
either directly or indirectly, shall provide an enrollee with a written description of the...
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34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings
as used in this article: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare
benefit plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
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27-45-2
Section 27-45-2 Definitions. As used in this article, the following terms shall have
the respective meanings herein set forth, unless the context shall otherwise require: (1)
ALABAMA INSURANCE CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall
have the meaning ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning
ascribed in Section 27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively,
shall have the meanings ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any
obligation under covered policies or employee benefit plans. (6) COVERED POLICY OR PLAN. Any
policy, employee benefit plan, or contract within the scope of this article. (7) HEALTH INSURANCE
POLICY. Any individual, group, blanket, or franchise insurance policy, insurance agreement,
or group hospital service contract providing for pharmaceutical services, including without
limitation, prescription drugs, incurred as a result of accident or sickness, or to prevent
same....
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20-2-190
Section 20-2-190 Penalties; sale of ephedrine, etc.; Alabama Drug Abuse Task Force.
(a) Any person who manufactures, sells, transfers, receives, or possesses a listed precursor
chemical violates this article if the person: (1) Knowingly fails to comply with the reporting
requirements of this article; (2) Knowingly makes a false statement in a report or record
required by this article or the rules adopted thereunder; (3) Is required by this article
to have a listed precursor chemical license or permit, and is a person as defined by this
article, and knowingly or deliberately fails to obtain such a license or permit. An offense
under this subsection shall constitute a Class C felony. (b) Notwithstanding the provisions
of Section 20-2-188, a person who possesses, sells, transfers, or otherwise furnishes
or attempts to solicit another or conspires to possess, sell, transfer, or otherwise furnish
a listed precursor chemical or a product containing a precursor chemical or ephedrine or...
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34-24-604
Section 34-24-604 Annual registration. (a) Beginning January 1, 2014, and continuing
each year thereafter: (1) All physicians providing pain management services shall obtain a
pain management registration from the board. (2) All physicians who otherwise meet the criteria
established by the board shall obtain a pain management registration from the board. (b) To
register, a physician applicant shall submit the following to the board: (1) A completed application
on a form prescribed by the board. (2) Proof of a current drug enforcement administration
registration. (3) Proof of an Alabama controlled substances certificate. (4) Proof of a current
registration with the Alabama Prescription Drug Monitoring Program. (5) A list of all registrants
who own, co-own, operate, or provide pain management services in the practice location. (6)
The disclosure of any controlled substances certificate or registration denial, restriction,
or discipline imposed on the registrant, or any disciplinary act...
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27-44-3
Section 27-44-3 Scope of chapter. (a) This chapter shall provide coverage for the policies
and contracts specified in subsection (b) as follows: (1) To persons who, regardless of where
they reside (except for non-resident certificate holders under group policies or contracts),
are the beneficiaries, assignees, or payees of the persons covered under subdivision (2).
(2) To persons who are owners of or certificate holders under the policies or contracts, other
than structured settlement annuities, and in each case who are either of the following: a.
Residents b. Not residents, but only under all of the following conditions: 1. The insurer
that issued the policies or contracts is domiciled in this state. 2. The states in which the
persons reside have associations similar to the association created by this chapter. 3. The
persons are not eligible for coverage by an association in any other state due to the fact
the insurer was not licensed in the state at the time specified in the state's...
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