reglab/housing_qa huggingface dataset:
18 DE Code § 3321A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter II. Maximum Allowable Cost Pricing for Prescription Drugs and Reimbursement for and Provision of Pharmacy Goods or Services [For Application of This Subchapter, See 80 Del. Laws, C. 245, § 2; and 83 Del. Laws, C. 256, § 15]|§ 3321A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2].

§ 3321A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2]. As used in this subchapter:  (1) “Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device. (2) “Contracted pharmacy” means a pharmacy that participates in the network of a pharmacy benefits manager through a contract with a pharmacy benefits manager, a pharmacy services administration organization, or a group purchasing organization. (3) “Drug shortage list” means a list of drug products listed on the federal Food and Drug Administration's Drug Shortages website. (4) “Insurer” means any entity that provides health insurance coverage in this State as defined in § 903 of this title. (5) “Maximum allowable cost” means the maximum amount that a pharmacy benefits manager will reimburse a pharmacist or pharmacy for the cost of a multi-sourced drug, medical product, or device. (6) “Maximum allowable cost list” means the multi-source generic drugs, medical products, and devices for which a maximum allowable cost has been established by a pharmacy benefits manager or a purchaser. (7) “Network providers” means those pharmacists and pharmacies who provide covered health-care services or supplies to an insured or a member pursuant to a contract with an insurer or pharmacy benefits manager. (8) “Pharmacist” means as defined under § 2502 of Title 24. (9) “Pharmacy” means as defined under § 2502 of Title 24. (10) “Pharmacy benefits management services” means as defined under § 3351A of this title.  (11) “Pharmacy benefits manager” means as defined under § 3302A of this title. (12) “Purchaser” means as defined under § 3351A of this title. 80 Del. Laws, c. 245, § 1;  82 Del. Laws, c. 115, § 1;
18 DE Code § 3322A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter II. Maximum Allowable Cost Pricing for Prescription Drugs and Reimbursement for and Provision of Pharmacy Goods or Services [For Application of This Subchapter, See 80 Del. Laws, C. 245, § 2; and 83 Del. Laws, C. 256, § 15]|§ 3322A. Exclusions [For application of this section, see 80 Del. Laws, c. 245, § 2].

§ 3322A. Exclusions [For application of this section, see 80 Del. Laws, c. 245, § 2]. This subchapter does not apply to the Department of Health and Human Services in the performance of its duties in administering fee-for-service Medicaid under Titles XIX and XXI of the Social Security Act [42 U.S.C. §§ 1396 et seq., 1397aa et seq.]. 80 Del. Laws, c. 245, § 1;
18 DE Code § 3325A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter II. Maximum Allowable Cost Pricing for Prescription Drugs and Reimbursement for and Provision of Pharmacy Goods or Services [For Application of This Subchapter, See 80 Del. Laws, C. 245, § 2; and 83 Del. Laws, C. 256, § 15]|§ 3325A. Reimbursement for and provision of pharmacy goods [For application of this statute, see 83 Del. Laws, c. 256, § 15].

§ 3325A. Reimbursement for and provision of pharmacy goods [For application of this statute, see 83 Del. Laws, c. 256, § 15]. (a) For purposes of this section:  (1) “Affiliate” means a pharmacy or pharmacist that directly or indirectly, through 1 or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership or control with, a pharmacy benefits manager. (2) “Pharmaceutical wholesaler” means a person that sells and distributes a pharmaceutical product and offers regular and private delivery to a pharmacy. (3) “Pharmacy acquisition cost” means the amount that a pharmaceutical wholesaler charges for a pharmaceutical product as listed on the pharmacy's billing invoice. (4) “Pharmacy goods or services” means 1 or more of the following provided by a pharmacist or pharmacy:  a. A single-sourced drug, multi-sourced drug, or compounded drug. b. A medical product. c. A medical device. d. A service. (b) A pharmacy benefits manager may not reimburse a pharmacist or pharmacy for pharmacy goods or services in an amount less than the amount the pharmacy benefits manager reimburses itself or an affiliate for the same pharmacy goods or services. (c) If the amount reimbursed by a pharmacy benefits manager for pharmacy goods or services is less than the pharmacy acquisition cost for the same pharmacy goods or services, a pharmacist or pharmacy may decline to provide the pharmacy goods or services to a patient. (d) A pharmacist or pharmacy acting under subsection (c) of this section shall do all of the following:  (1) Inform the patient that the pharmacist or pharmacy has made the decision not to provide pharmacy goods or services to the patient under subsection (c) of this section because of the costs associated with providing the pharmacy goods or services. (2) Provide the patient with a list of pharmacies in the area that may provide the pharmacy goods or services.83 Del. Laws, c. 256, § 5;
18 DE Code § 3331A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter III. Permitted Disclosures Related to Prescription Drugs [For Application of This Subchapter, See 81 Del. Laws, C. 378, § 2].|§ 3331A. Definitions [For application of this section, see 81 Del. Laws, c. 378, § 2; and 83 Del. Laws, c. 256, § 15].

§ 3331A. Definitions [For application of this section, see 81 Del. Laws, c. 378, § 2; and 83 Del. Laws, c. 256, § 15]. For purposes of this subchapter:  (1) “Pharmacist” means as defined in § 2502 of Title 24. (2) “Pharmacy” means as defined in § 2502 of Title 24. (3) “Pharmacy benefit manager” means as defined under § 3302A of this title. (4) “Substitute” means as defined in § 2502 of Title 24.81 Del. Laws, c. 378, § 1;  83 Del. Laws, c. 256, § 6;
18 DE Code § 3332A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter III. Permitted Disclosures Related to Prescription Drugs [For Application of This Subchapter, See 81 Del. Laws, C. 378, § 2].|§ 3332A. Permitted disclosures related to prescription drugs [For application of this section, see 81 Del. Laws, c. 378, § 2; and 81 Del. Laws, c. 256, §  15].

§ 3332A. Permitted disclosures related to prescription drugs [For application of this section, see 81 Del. Laws, c. 378, § 2; and 81 Del. Laws, c. 256, §  15]. A contract between a pharmacy benefits manager and a pharmacy may not prohibit a pharmacy or pharmacist from doing any of the following:  (1) Providing a patient with information regarding the retail price of a prescription drug or the amount of the cost share for which the patient is responsible for a prescription drug. (2) Discussing with a patient information regarding the retail price of a prescription drug or the amount of the cost share for which the patient is responsible for a prescription drug. (3) If a more affordable substitute is available, selling the more affordable substitute to the patient.81 Del. Laws, c. 378, § 1;  83 Del. Laws, c. 256, § 7;
18 DE Code § 3335A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter IV. Prior Authorization of Emergency Prescriptions and Prescriptions for Chronic or Long-Term Conditions|§ 3335A. Definitions.

§ 3335A. Definitions. As used in this subchapter:  (1) “Emergency” means a situation that will result in loss of life, limb or organ function. (2) “Pharmacy benefit manager” has the meaning given in § 3302A of this title. (3) “Prior authorization” means a requirement by a carrier or health-insurance plan that providers submit a request or other prior notification to the carrier for evaluation of appropriateness of the request or if the prescription is medically necessary before treatment is rendered. Prior authorization lets the insured and provider know in advance which pharmaceuticals are considered by the insurer to be medically necessary.81 Del. Laws, c. 379, § 1;
18 DE Code § 3336A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter IV. Prior Authorization of Emergency Prescriptions and Prescriptions for Chronic or Long-Term Conditions|§ 3336A. Prior authorization of emergency prescriptions.

§ 3336A. Prior authorization of emergency prescriptions. A pharmacy benefit manager may not require prior authorization for coverage of a 72-hour supply of medication that is for a noncontrolled substance in an emergency situation. 81 Del. Laws, c. 379, § 1;
18 DE Code § 3337A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter IV. Prior Authorization of Emergency Prescriptions and Prescriptions for Chronic or Long-Term Conditions|§ 3337A. Prior authorization of prescriptions for chronic or long-term conditions.

§ 3337A. Prior authorization of prescriptions for chronic or long-term conditions. (a) A prior authorization form for a prescription medication shall include a question regarding whether the prescription medication is for a chronic or long-term condition for which the prescription medication may be necessary for the life of the patient. (b) If a prescriber indicates on a prior authorization form that the prescription medication is for a chronic or long-term condition for which the prescription medication may be necessary for the life of the patient, the pharmacy benefit manager may not request a reauthorization for the same prescription medication more frequently than every 12 months. (c) In the same communication in which a pharmacy benefit manager or the pharmacy benefit manager's agent requests a prior authorization for a prescription medication that has therapeutically equivalent medications that do not require a prior authorization from a prescriber, the pharmacy benefit manager or the pharmacy benefit manager's agent shall provide the prescriber with a list of alternative prescription medications of the same class and family as the requested medication.  (d) Prescribers that utilize e-prescribing shall receive alternate medications from the pharmacy benefit manager for prescription medications that do not require a prior authorization before the completion of the e-prescribing transaction. (e) A pharmacy benefit manager or the pharmacy benefit manager's agent shall provide alternative medications for therapeutically equivalent medications to the pharmacy that require prior authorization on the National Council for Prescription Drug Programs response transaction to a denied claim for prior authorization. 81 Del. Laws, c. 379, § 1;
18 DE Code § 3351A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3351A. Definitions [For application of this statute, see 83 Del. Laws, c. 256, § 15].

§ 3351A. Definitions [For application of this statute, see 83 Del. Laws, c. 256, § 15]. For purposes of this subchapter:  (1) “Pharmacy benefits management services” means all of the following:  a. The procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries. b. The administration or management of prescription drug coverage provided by a purchaser for beneficiaries. c. Any of the following services provided with regard to the administration of prescription drug coverage:  1. Mail service pharmacy. 2. Claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries. 3. Clinical formulary development and management services. 4. Rebate contracting and administration. For purposes of this paragraph (1)c.4., “rebate” means as defined in § 3361A of this title. 5. Patient compliance, therapeutic intervention, and generic substitution programs. 6. Disease management programs. (2) “Pharmacy benefits manager” means as defined under § 3302A of this title. (3) “Purchaser” means a person that does all of the following:  a. Provides prescription drug coverage or benefits in this State. b. Enters into agreement with a pharmacy benefits manager for the provision of pharmacy benefits management services.82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 8;
18 DE Code § 3352A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3352A. Applicability.

§ 3352A. Applicability. This subchapter does not apply to plans of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act, 42 U.S.C. §§ 1395 et seq., 1396 et seq., and 1397aa et seq., known as Medicare, Medicaid, or any other similar coverage under a state or federal government plan. 82 Del. Laws, c. 115, § 4;
18 DE Code § 3353A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3353A. Registration required [For application of this statute, see 83 Del. Laws, c. 256, § 15].

§ 3353A. Registration required [For application of this statute, see 83 Del. Laws, c. 256, § 15]. (a) A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in this State to a purchaser. (b) A purchaser may not enter into an agreement or contract with a pharmacy benefits manager that has not registered with the Commissioner. (c) A pharmacy benefits manager applying for registration shall do all of the following:  (1) File with the Commissioner an application on the form that the Commissioner provides. (2) Pay to the Commissioner a $1,000 nonrefundable registration fee. (d) The Commissioner may require any additional information or submissions from a pharmacy benefits manager that may be reasonably necessary to verify the information contained in the application.  (e) Subject to § 3355A of this title, the Commissioner shall register each pharmacy benefits manager that meets the requirements of this section. (f) Except where prohibited by state or federal law, a pharmacy benefits manager applying for registration is deemed to have appointed the Commissioner as agent for service of process in an action or proceeding arising in this State out of or in connection with the exercise of the registration. The appointment of the Commissioner as agent for service of process is irrevocable during the period within which a cause of action against the pharmacy benefits manager may arise out of transactions with respect to pharmacy benefits management services provided in this State. The process must be served on the Commissioner or a Deputy Insurance Commissioner or another person designated by the Commissioner by rule or regulation. 82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 9;
18 DE Code § 3354A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3354A. Expiration and renewal of registration [For application of this statute, see 83 Del. Laws, c. 256. §  15].

§ 3354A. Expiration and renewal of registration [For application of this statute, see 83 Del. Laws, c. 256. §  15]. (a) A pharmacy benefits manager registration expires on May 1 after its effective date unless it is renewed as provided under this section. (b) A pharmacy benefits manager may renew its registration for an additional 1-year term if the pharmacy benefits manager otherwise is entitled to be registered and does all of the following:  (1) Files with the Commissioner a registration renewal application on the form that the Commissioner requires.  (2) Pays to the Commissioner a $1,000 nonrefundable renewal fee. (c) An application for renewal of a pharmacy benefits manager registration is to be considered made in a timely manner if it is postmarked on or before the date the pharmacy benefits manager's registration expires. (d) The Commissioner may require additional information or submissions from a pharmacy benefits manager that may be reasonably necessary to verify the information contained in the registration renewal application. (e) Subject to §§ 3355A of this title, the Commissioner shall renew the registration of each pharmacy benefits manager that meets the requirements of this section. 82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 10;
18 DE Code § 3355A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3355A. Denial, suspension, or revocation of registration [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3355A. Denial, suspension, or revocation of registration [For application of this statute, see 83 Del. Laws, c. 256, §  15]. (a) The Commissioner may deny a registration to a pharmacy benefits manager applicant or refuse to renew, suspend, or revoke the registration of, or issue a cease and desist order to, a pharmacy benefits manager if the pharmacy benefits manager, or an officer, director, or employee of the pharmacy benefits manager, does any of the following:  (1) Makes a material misstatement, misrepresentation, or omission in a registration or registration renewal application. (2) Fraudulently or deceptively obtains or attempts to obtain a registration or renewal of a registration. (3) In connection with the administration of pharmacy benefits management services, commits fraud or engages in illegal or dishonest activities. (4) Violates any provision of this chapter or a regulation adopted under this chapter. (b) [Repealed.] (c) If the action by the Commissioner is to deny or not renew a registration, the Commissioner shall notify the pharmacy benefits manager of the decision, in writing, including the reason for the denial or nonrenewal of the registration. The pharmacy benefits manager may, within 10 days after the Commissioner provides notice under this subsection, make written demand on the Commissioner for a hearing before the Commissioner to determine the reasonableness of the Commissioner's action. A hearing under this subsection must be held under §§ 323 through 328 of this title. (d) This section does not limit any other regulatory authority of the Commissioner under this title. 82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 11;
18 DE Code § 3356A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3356A. Recordkeeping requirements.

§ 3356A. Recordkeeping requirements. A pharmacy benefits manager shall maintain adequate books and records about each purchaser for which the pharmacy benefits manager provides pharmacy benefits management services as follows:  (1) In accordance with prudent standards of record keeping. (2) For the duration of the agreement between the pharmacy benefits manager and the purchaser. (3) For 3 years after the pharmacy benefits manager ceases to provide pharmacy benefits management services for the purchaser.82 Del. Laws, c. 115, § 4;
18 DE Code § 3357A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3357A. Examination of affairs, transactions, accounts, and records.

§ 3357A. Examination of affairs, transactions, accounts, and records. (a) Whenever the Commissioner considers it advisable, the Commissioner may examine the affairs, transactions, accounts, and records of a registered pharmacy benefits manager. (b) The examination must be conducted under § 320 of this title. (c) The expense of an examination is to be borne by the pharmacy benefits manager being examined. The expense includes the reasonable and proper expenses of the Commissioner, and the Commissioner's examiners and assistants, including expert assistance, and a reasonable per diem as to the examiners and assistants as necessarily incurred in the examination. The pharmacy benefits manager examined shall promptly pay the examination expense on presentation by the Commissioner or the Commissioner's examiner of a reasonably detailed written account of the examination expense. (d) The Commissioner shall issue reports of the examination and investigation under § 321 of this title. 82 Del. Laws, c. 115, § 4;
18 DE Code § 3358A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter V. Registration of Pharmacy Benefits Managers|§ 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices.

§ 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices. A pharmacy benefits manager may not ship, mail, or deliver prescription drugs or devices to a person in this State through a nonresident pharmacy unless the nonresident pharmacy holds a permit issued under § 2535 of Title 24. 82 Del. Laws, c. 115, § 4;
18 DE Code § 3361A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter VI. Pharmacy Benefits Manager Network Requirements [For Application of This Statute, See 83 Del. Laws, C. 256, §? 15]|§ 3361A. Definitions [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3361A. Definitions [For application of this statute, see 83 Del. Laws, c. 256, §  15]. For purposes of this subchapter:  (1) “Claim” means as defined under § 3321A of this title.  (2) “Insured” means an individual covered by health insurance offered by an insurer. (3) “Insurer” means as defined under § 3321A of this title. (4) “Pharmacist” means as defined under § 2502 of Title 24. (5) “Pharmacy” means as defined under § 2502 of Title 24. (6) “Pharmacy benefits manager” means as defined under § 3302A of this title. (7) “Pharmacy benefits manager network” means a network of pharmacists or pharmacies that are offered by an agreement or contract to provide pharmacy goods or services. (8) “Pharmacy goods or services” means as defined under § 3325A of this title. (9) a. “Rebate” means a discount or other price concession, or a payment that is both of the following:  1. Based on utilization of a prescription drug. 2. Paid by a manufacturer or third party, directly or indirectly, to the pharmacy benefits manager, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy. b. “Rebate” includes incentives, disbursements, and reasonable estimates of a volume-based or category-based discount.83 Del. Laws, c. 256, § 12;