LD 554
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LR 1315
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income, long-term care or other limited benefit health
insurance policies and contracts.

 
B.__"Covered individual" means a member, participant,
enrollee, contract holder or policy holder or beneficiary of
a covered entity who is provided health coverage by the
covered entity.__"Covered individual" includes a dependent
or other person provided health coverage through a policy,
contract or plan for a covered individual.

 
C.__"Generic drug" means a chemically equivalent copy of a
brand-name drug with an expired patent.

 
D.__"Labeler" means an entity or person that receives
prescription drugs from a manufacturer or wholesaler and
repackages those drugs for later retail sale and that has a
labeler code from the federal Food and Drug Administration
under 21 Code of Federal Regulations, 270.20 (1999).

 
E.__"Pharmacy benefits management" means the procurement of
prescription drugs at a negotiated rate for dispensation
within this State to covered individuals, the administration
or management of prescription drug benefits provided by a
covered entity for the benefit of covered individuals or any
of the following services provided with regard to the
administration of pharmacy benefits:

 
(1)__Mail service pharmacy;

 
(2)__Claims processing, retail network management and
payment of claims to pharmacies for prescription drugs
dispensed to covered individuals;

 
(3)__Clinical formulary development and management
services;

 
(4)__Rebate contracting and administration;

 
(5)__Certain patient compliance, therapeutic
intervention and generic substitution programs; and

 
(6)__Disease management programs.

 
F.__"Pharmacy benefits manager" means an entity that
performs pharmacy benefits management.__"Pharmacy benefits
manager" includes a person or entity acting for a pharmacy
benefits manager in a contractual or employment relationship
in the performance of pharmacy benefits management for a
covered entity and includes mail service pharmacy.


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