CHAPTER 21-I DEPARTMENT OF ADMINISTRATIVE SERVICES
Hampshire Prescription Drug Competitive Marketplace
Section 21-I:97
21-I:97 Definitions. –
In this subdivision:
I. "Department" means the department of administrative services.
II. "Pharmacy benefits manager" or "PBM" means a person, business, or other entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefits manager, that, pursuant to a contract with the health carrier or self-funded health benefit plan, manages the prescription drug coverage provided by the health carrier or self-funded health benefit plan, including, but not limited to, providing claims processing services for prescription drugs, performing drug utilization review, processing drug prior authorization requests, adjudication of grievances or appeals related to prescription drug coverage, contracting with network pharmacies, and controlling the cost of covered prescription drugs.
III. "PBM reverse auction" means an automated, transparent, and dynamically competitive bidding process conducted online that starts with an opening round of bids and allows qualified PBM bidders to counter-offer a lower price for as many rounds of bidding as determined by the department of administrative services or its authorized representative conducting the reverse auction for a multiple health plan prescription drug purchasing group.
IV. "Price" means the projected cost of a PBM proposal or "bid" for providing prescription drug benefits pursuant to this part, to enable "apples-to-apples" comparison of the costs of competing PBM proposals over the duration of the PBM services contract.
V. "Real-time" means within no more than 12 hours.
VI. "PBA" means a participant bidding agreement entered into by all participants in the PBM reverse auction prior to participation therein.