reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-22 - Application by administrator--Contents--Fee.

58-29D-22. Application by administrator--Contents--Fee.
An administrator shall apply to the director upon a form to be furnished by the director. The application shall include or be accompanied by the following information and documents:
(1)All basic organizational documents of the administrator, including any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement, and other applicable documents, and all amendments to such documents;
(2)The bylaws, rules, regulations, or similar documents regulating the internal affairs of the administrator;
(3)The names, addresses, official positions, and professional qualifications of the individuals who are responsible for the conduct of affairs of the administrator; including all members of the board of directors, board of trustees, executive committee, or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership or association; shareholders holding directly or indirectly ten percent or more of the voting securities of the administrator; and any other person who exercises control or influence over the affairs of the administrator;
(4)Annual financial statements or reports for the two most recent years which prove that the applicant is solvent and such information as the director may require in order to review the current financial condition of the applicant;
(5)A statement describing the business plan including information on staffing levels and activities proposed in this state and nationwide. The plan shall provide details setting forth the administrator's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, record keeping, and underwriting;
(6)If the applicant will be managing the solicitation of new or renewal business, proof that it employs or has contracted with an insurance producer licensed by this state for solicitation and taking of applications. Any applicant shall provide proof that it has a license as a life and health insurance producer in this state; and
(7)Information regarding administrative actions, criminal convictions, or guilty pleas.
The director may request additional information if the information provided pursuant to this section is inaccurate, incomplete, or unclear. If an applicant fails to provide the requested information within thirty days of the receipt of the any written request pursuant to subdivisions (1) to (7), inclusive, it is grounds for denial of an application.
Any material change in the above information shall be filed with the director within thirty days. A filing fee of five hundred dollars shall accompany the application.
Source:
SL 1992, ch 352, §22; SL 2001, ch 286, §153; SL 2013, ch 253, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-22.1 - Annual financial statement--Contents of application--Required audit.

58-29D-22.1  .  Annual financial statement--Contents of application--Required audit.
Any annual financial statement or report required under §58-29D-22 must be audited. The applicant is presumed to be solvent if the applicant has a positive net worth.
If the applicant has been in existence for less than two fiscal years, the applicant shall include in the application all financial statements or reports, certified by an officer of the applicant and prepared in accordance with generally accepted accounting principles, for any completed fiscal year and for any month during the current fiscal year for which the financial statements or reports have been completed. If information provided pursuant to this section is prepared on a consolidated or combined basis, the applicant shall include a columnar consolidating or combining worksheet with the report or renewal and shall include in the worksheet the following:
(1) Amounts shown on the consolidated audited financial report or renewal;
(2) Amounts for each entity stated separately; and
(3) Explanations of consolidating and eliminating entries.
Source:  SL 2020, ch 211, § 1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-23 - Inspection of applicant's contracts.

58-29D-23. Inspection of applicant's contracts.
The applicant shall make available for inspection by the director copies of all contracts with insurers or other persons utilizing the services of the administrator.
Source:
SL 1992, ch 352, §23.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-24 - Denial of license.

58-29D-24. Denial of license.
The director may not issue a license if the director determines that the administrator, or any individual responsible for the conduct of affairs of the administrator as defined in subdivision 58-29D-22(3), is not qualified for licensure by reason of §58-30-167.
Source:
SL 1992, ch 352, §24; SL 2002, ch 240, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-25 - Validity of license.

58-29D-25. Validity of license.
A license issued under this chapter shall remain valid, unless surrendered, suspended, or revoked by the director, for so long as the administrator continues in business in this state and remains in compliance with this chapter.
Source:
SL 1992, ch 352, §25.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-26 - Conditions not requiring license.

58-29D-26. Conditions not requiring license.
An administrator is not required to hold a license as an administrator in this state if all of the following conditions are met:
(1)The administrator has its principal place of business in another state;
(2)The administrator is not soliciting business as an administrator in this state;
(3)In the case of any group policy or plan of insurance serviced by the administrator and less than one hundred certificate holders reside in this state.
Source:
SL 1992, ch 352, §26.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-27 - Servicer of certain employee benefit plans--Exempt from licensure--Requirements.

58-29D-27. Servicer of certain employee benefit plans--Exempt from licensure--Requirements.
A person is not required to hold a license as an administrator in this state if the person exclusively provides services to one or more bona fide employee benefit plans, each of which is established by an employer or an employee organization, or both, and for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974. Any person not required to hold a license shall register with the director annually, verifying the person's status if the person directly or indirectly underwrites, collects charges or premiums from, or adjusts or settles claims of residents of this state in connection with a self-funded plan other than a governmental or church plan offering life, annuity, or health coverage.
Source:
SL 1992, ch 352, §27; SL 2020, ch 211, § 2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-28 - Notice of administrator's change in circumstance.

58-29D-28. Notice of administrator's change in circumstance.
An administrator shall immediately notify the director of any material change in its ownership, control, or other fact or circumstance affecting its qualification for a license in this state.
Source:
SL 1992, ch 352, §28.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-29 - Waiver of application requirements.

58-29D-29. Waiver of application requirements.
Upon request from an administrator, the director may waive the application requirements of §58-29D-22 if the administrator has a valid license as an administrator issued in a state which has standards for administrators that are at least as stringent as those contained in this chapter. If waived, the administrator shall register with the director in this state. The waiver shall automatically lapse if the third party administrator granted a waiver is no longer licensed in the state for which the waiver was granted. Any waiver given by this section does not extend to any suspension or revocation of licensure or registration pursuant to §58-29D-31.
Source:
SL 1992, ch 352, §29; SL 2001, ch 285, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-30 - Annual renewal of administrator--Fee--Lapse of license or registration.

58-29D-30. Annual renewal of administrator--Fee--Lapse of license or registration.
Each administrator licensed or registered shall file an annual renewal for the preceding calendar year with the director on or before July first of each year, or within such extension of time as the director for good cause may grant. The renewal shall be in the form and contain such matters as the director prescribes and shall be verified by at least two officers of the administrator. The annual renewal shall include the complete names and addresses of all insurers with which the administrator had an agreement during the preceding fiscal year. At the time of filing its annual renewal, the administrator shall pay a filing fee of two hundred fifty dollars. Failure to file such renewal shall result in lapsing of the license or registration of the administrator.
Source:
SL 1992, ch 352, §30; SL 1999, ch 255, §1; SL 2012, ch 248, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-31 - Grounds for denial, suspension, or revocation of license or registration.

58-29D-31. Grounds for denial, suspension, or revocation of license or registration.
The application or annual renewal shall be denied and the license or registration of an administrator shall be suspended or revoked if the director finds that the administrator or applicant:
(1)Is in an unsound financial condition;
(2)Is using such methods or practices in the conduct of its business so as to render its further transaction of business in this state hazardous or injurious to insured persons or the public;
(3)Has failed to pay any judgment rendered against it in this state within sixty days after the judgment has become final;
(4)Has violated any lawful rule or order of the director or any provision of the insurance laws of this state;
(5)Has refused to be examined or to produce its accounts, records, and files for examination, or if any of its officers has refused to give information with respect to its affairs or has refused to perform any other legal obligation as to such examination, if required by the director;
(6)Has, without just cause, refused to pay proper claims or perform services arising under its contracts or has, without just cause, caused covered individuals to accept less than the amount due them or caused covered individuals to employ attorneys or bring suit against the administrator to secure full payment or settlement of such claims;
(7)Is affiliated with or under the same general management or interlocking directorate or ownership as another administrator or insurer which unlawfully transacts business in this state without having a license;
(8)At any time fails to meet any qualification for which issuance of the certificate could have been refused had such failure then existed and been known to the Division of Insurance;
(9)Has been convicted of, or has entered a plea of guilty or nolo contendere to, a felony without regard to whether adjudication was withheld;
(10)Is under suspension or revocation in another state; or
(11)Has supplied false information to the director.
Source:
SL 1992, ch 352, §31; SL 2001, ch 285, §5; SL 2013, ch 253, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-32 - Immediate suspension of license--No notice required.

58-29D-32. Immediate suspension of license--No notice required.
The director may, in his discretion and without advance notice of hearing thereon, immediately suspend the certificate of any administrator if the director finds that one or more of the following circumstances exist:
(1)The administrator is insolvent or impaired;
(2)A proceeding for receivership, conservatorship, rehabilitation, or other delinquency proceeding regarding the administrator has been commenced in any state;
(3)The financial condition or business practices of the administrator otherwise pose an imminent threat to the public health, safety, or welfare of the residents of this state.
Source:
SL 1992, ch 352, §32.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-32.1 - Notice of denial of application or renewal--Request for hearing--Hearing on suspension or revocation--Notice.

58-29D-32.1. Notice of denial of application or renewal--Request for hearing--Hearing on suspension or revocation--Notice.
If the director denies an application or annual renewal for a license or registration, the director shall notify the applicant or licensee and advise, in writing, the applicant or licensee of the reason for the denial. The applicant or licensee may make a written request to the director within thirty days of the date of the denial for a hearing to determine the reasonableness of the director's action. A notice of hearing shall be issued within thirty days of receipt of a written request.
The director shall suspend for not more than twelve months, or may revoke or refuse to continue, any license or registration issued under this chapter after a hearing. Notice of such hearing and of the charges against the licensee or registrant pursuant to §58-29D-31 shall be given at least twenty days before a hearing. Notice of hearing shall be issued within twenty days of the director's suspension under §58-29D-32 which shall include the reasons for suspension and may include grounds for revocation under §58-29D-31. Any hearing under §58-29D-32 shall be held within thirty days of the date of the director's suspension.
Any hearing under the provisions of this section shall be held pursuant to chapter 1-26. Nothing in this section or §58-29D-31 applies to a renewal which is lapsed pursuant to §58-29D-30.
Source:
SL 2013, ch 253, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-33 - Money penalty in lieu of suspension or revocation.

58-29D-33. Money penalty in lieu of suspension or revocation.
If the director finds that one or more grounds exist for the denial of an application, suspension, or revocation of a license issued under this chapter, the director may, in lieu of denial, suspension, or revocation, impose a money penalty pursuant to §58-4-28.1.
Source:
SL 1992, ch 352, §33; SL 2000, ch 235, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29D - Regulation Of Life And Health Administrators › Section 58-29D-34 - Promulgation of rules.

58-29D-34. Promulgation of rules.
The director may promulgate rules pursuant to chapter 1-26 to provide for the enforcement and administration necessary to administer this chapter.
Source:
SL 1992, ch 352, §34.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-2 - Licensure requirement--Pharmacy benefit manager.

58-29E-2. Licensure requirement--Pharmacy benefit manager.
A person may not act as a pharmacy benefit manager in this state without a license to operate as a third party administrator pursuant to chapter 58-29D. Sections 58-29D-26, 58-29D-27, and 58-29D-29 do not apply to pharmacy benefits managers.
Source: SL 2004, ch 311, §2; SL 2013, ch 253, §5; SL 2023, ch 166, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-3 - Performance of duties--Good faith.

58-29E-3. Performance of duties--Good faith.
Each pharmacy benefit manager shall perform its duties in good faith and with fair dealing toward the third-party payor.
Source: SL 2004, ch 311, §3; SL 2023, ch 166, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-4 - Request for disclosure of rebates and other revenues.

58-29E-4. Request for disclosure of rebates and other revenues.
A third-party payor may request that a pharmacy benefit manager, with which it has a pharmacy benefit management services contract, disclose to the third-party payor the amount of all rebate revenues and the nature, type, and amounts of all other revenues that the pharmacy benefit manager receives from each pharmaceutical manufacturer with which the pharmacy benefit manager has a contract.
Annually, at the time of contract renewal, the pharmacy benefit manager shall disclose in writing:
(1)The aggregate amount, and for a list of drugs to be specified in the contract, the specific amount, of all rebates and other retrospective utilization discounts that are received by the pharmacy benefit manager, directly or indirectly, from each pharmaceutical manufacturer, and which are earned in connection with the dispensing of prescription drugs to covered individuals of the health benefit plans issued by the third-party payor or for which the third-party payor is the designated administrator;
(2)The nature, type, and amount of all other revenue received by the pharmacy benefit manager, directly or indirectly, from each pharmaceutical manufacturer, for any other products or services, provided to the pharmaceutical manufacturer by the pharmacy benefit manager, with respect to programs that the third-party payor offers or provides to its covered individuals; and
(3)Any prescription drug utilization information requested by the third-party payor and relating to covered individuals.
A pharmacy benefit manager shall, within thirty days, provide the information requested in accordance with this section.
If requested, the information must be provided no less than once each year.
The contract entered into between the pharmacy benefit manager and the third-party payor must set forth any fees to be charged for drug utilization reports requested by the third-party payor.
Source: SL 2004, ch 311, §4; SL 2023, ch 166, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-5 - Permission to contact covered individual.

58-29E-5. Permission to contact covered individual.
A pharmacy benefit manager, unless authorized pursuant to the terms of its contract with a third-party payor, may not contact any covered individual, without the express written permission of the third-party payor.
Source: SL 2004, ch 311, §5; SL 2023, ch 166, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-6 - Disclosure of rebates and other revenues--Confidentiality.

58-29E-6. Disclosure of rebates and other revenues--Confidentiality.
Except for utilization information, a third-party payor shall maintain information disclosed in response to a request under §58-29E-4 as confidential and proprietary information, and may not use that information for any other purpose or disclose that information to any other person, except as provided in this chapter or in the pharmacy benefit management services contract between the parties.
A third-party payor that discloses information, in violation of this section, is subject to an action for injunctive relief and is liable for any damages that are the direct and proximate result of the disclosure.
Nothing in this section prohibits a third-party payor from disclosing confidential or proprietary information to the director, upon request. Information obtained by the director in accordance with this section is confidential and privileged, and is not open to public inspection or disclosure.
Source: SL 2004, ch 311, §6; SL 2023, ch 166, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-7 - Annual audit of pharmacy benefit manager authorized.

58-29E-7. Annual audit of pharmacy benefit manager authorized.
A third-party payor that has contracted with a licensed pharmacy benefit manager may audit the pharmacy benefit manager once each calendar year. The audit authorized by this section is in addition to any other statutory or contractual audit rights. As part of the audit, a third-party payor may request:
(1)All reimbursements paid to retail pharmacies, on a claim level, for all customers of the pharmacy benefit manager in this state, including ancillary charges, claw backs, dispensing fees, drug-specific reimbursements, other fees, rebates, and reimbursement adjustments;
(2)Differences in reimbursement amounts paid to affiliated and unaffiliated pharmacies, including differences in dispensing fees and reimbursed ingredient costs;
(3)Historical claims data, including:
(a)Acquisition costs;
(b)Administrative fees associated with claims;
(c)Amounts paid by a covered individual;
(d)Amounts paid by a third-party payor;
(e)Channels, whether mail or retail;
(f)Dispensing fees;
(g)Formulary tiers;
(h)Ingredient costs;
(i)Ingredient quantity;
(j)Sales tax;
(k)Supply availability by the number of days; and
(l)Usual and customary prices; and
(4)Aggregate rebate amounts, received by calendar quarter, directly or indirectly from manufacturers, including rebates from other entities affiliated with or related to the pharmacy benefit manager, if those entities negotiate or contract with manufacturers.
A pharmacy benefit manager shall, within thirty days, provide the information requested in accordance with this section, together with a certification, signed by the chief executive officer or the chief financial officer of the pharmacy benefit manager, attesting to the accuracy and completeness of the information.
Source: SL 2004, ch 311, §7; SL 2023, ch 166, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-7.1 - Prohibition on publication or disclosure of information.

58-29E-7.1. Prohibition on publication or disclosure of information.
Except as provided in chapter 58-17K, and in accordance with the audit provisions in §58-29E-7, a third-party payor that has contracted with a licensed pharmacy benefit manager may not publish, or directly or indirectly disclose:
(1)Any information that reveals the identity of a specific third-party payor or manufacturer;
(2)Prices charged for a specific drug or class of drugs;
(3)The amount of any rebates provided for a specific drug or class of drugs; or
(4)Any information that has the potential to compromise the financial, competitive, or proprietary nature of the pharmacy benefit manager's business.
The information referenced in §58-29E-7 is protected from disclosure as confidential and proprietary. The information is privileged and not open to public inspection or disclosure.
A third-party payor that has contracted with a licensed pharmacy benefit manager shall impose the confidentiality protections set forth in §58-29E-7 on any vendor or third party that may receive or have access to the information.
Source: SL 2023, ch 166, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-8 - Substitute drug--Dispensation.

58-29E-8. Substitute drug--Dispensation.
A pharmacy benefit manager may request that a lower-priced generic and therapeutically equivalent prescription drug be dispensed to a covered individual, as a substitute for a higher-priced prescription drug.
If the substitute prescription drug's net cost is higher for the covered individual or the third-party payor than the originally prescribed drug, the substitution may be made only for medical reasons that benefit the covered individual.
If a substitution is being requested pursuant to this section, the pharmacy benefit manager must obtain the approval of the prescribing health professional.
Nothing in this section permits the substitution of an equivalent drug product contrary to §36-11-46.2.
Source: SL 2004, ch 311, §8; SL 2023, ch 166, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-8.1 - Provision of information to a patient.

58-29E-8.1. Provision of information to a patient.
A pharmacy benefit manager may neither prohibit a pharmacist or pharmacy from, nor penalize a pharmacist or pharmacy for, informing a covered individual about:
(1)The cost of a prescription drug;
(2)The amount of reimbursement that the pharmacy will receive for dispensing the prescription drug;
(3)The cost and clinical efficacy of a more affordable alternative prescription drug, if one is available; and
(4)Any differential between the amount a covered individual would pay under the covered individual’s prescription drug benefit and a lower price the covered individual would pay for the prescription drug, if the covered individual obtained the prescription drug without making a claim for benefits on the covered individual’s prescription drug benefit.
Source: SL 2018, ch 281, §1; SL 2023, ch 166, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-9 - Rules--Content.

58-29E-9. Rules--Content.
The Division of Insurance shall promulgate rules, pursuant to chapter 1-26, to carry out the issuance of the license required by §58-29E-2 and the enforcement provisions of this chapter. The rules may include the following:
(1)Definition of terms;
(2)Use of prescribed forms;
(3)Reporting requirements;
(4)Enforcement procedures; and
(5)Protection of proprietary information and trade secrets.
Source:
SL 2004, ch 311, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-10 - Enforcement of chapter--Civil action.

58-29E-10. Enforcement of chapter--Civil action.
A third-party payor may bring a civil action to enforce this chapter or seek civil damages for a violation of this chapter.
Source: SL 2004, ch 311, §10; SL 2023, ch 166, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-12 - Charging cost share that exceeds amount retained by pharmacy--Prohibition.

58-29E-12. Charging cost share that exceeds amount retained by pharmacy--Prohibition.
A pharmacy benefit manager may not contractually require a pharmacy that is a participating provider in a health benefit plan provided by a third-party payor, from charging a covered individual or collecting from a covered individual a cost share for a prescription drug or pharmacy service that exceeds the amount retained by the pharmacist or pharmacy from all payment sources, for filling the prescription or providing the pharmacy service.
Source: SL 2019, ch 213, §1; SL 2023, ch 166, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-13 - Certain claims adjustments prohibited.

58-29E-13. Certain claims adjustments prohibited.
A pharmacy benefit manager may not, directly or indirectly, retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless:
(1)The adjustment is necessitated by a pharmacy audit conducted in accordance with chapter 58-29F;
(2)The adjustment is necessitated by a technical billing error;
(3)The original claim was found to have been fraudulently submitted; or
(4)The claim submission was a duplicate for which the pharmacy had already received payment.
Source: SL 2019, ch 213, §2; SL 2023, ch 166, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-14 - Adjustment of claim due to error in adjudication permitted.

58-29E-14. Adjustment of claim due to error in adjudication permitted.
Nothing in §§58-29E-12 to 58-29E-15, inclusive, shall prohibit a pharmacy benefit manager from adjusting claim payment for the benefit of a covered individual if there was an error in the adjudication of a claim submitted by or on behalf of the covered individual.
Source:
SL 2019, ch 213, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-15 - Discrimination prohibited against pharmacy participating in health plan under Public Health Service Act.

58-29E-15. Discrimination prohibited against pharmacy participating in health plan under Public Health Service Act.
No pharmacy benefit manager may discriminate against a pharmacy participating in a health plan as an entity authorized to participate under section 340B of the Public Health Service Act, as amended to January 1, 2019, or any pharmacy under contract with such an entity to provide prescriptions. For the purposes of this chapter, a retail pharmacy is any pharmacy licensed under the laws of this state, and no pharmacy benefit manager may, by contract, modify that definition.
Source:
SL 2019, ch 213, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-16 - Prohibition regarding the assessment or collection of fees.

58-29E-16. Prohibition regarding the assessment or collection of fees.
A pharmacy benefit manager may not assess, charge, or collect, from a pharmacy or pharmacist, any remuneration or fee, including:
(1)An accreditation fee;
(2)A brand effective rate fee;
(3)A claim processing fee;
(4)A credentialing fee;
(5)A dispensing fee;
(6)An effective rate fee;
(7)A generic effective rate fee;
(8)A pharmacy network participation fee; and
(9)A performance-based fee.
Source: SL 2023, ch 166, §14.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-17 - Placement on a maximum allowable cost list--Requirements--Promulgation of rules.

58-29E-17. Placement on a maximum allowable cost list--Requirements--Promulgation of rules.
Prior to placing a prescription drug on a maximum allowable cost list, a pharmacy benefit manager shall ensure that the prescription drug is:
(1)Listed as therapeutically and pharmaceutically equivalent in the latest edition of, or any supplement to, the Food and Drug Administration's publication entitled Approved Drug Products with Therapeutic Equivalence Evaluations, as adopted by the State Board of Pharmacy, in rules promulgated pursuant to chapter 1-26;
(2)Not obsolete or temporarily unavailable; and
(3)Available for purchase, without limitation, by every pharmacy in this state, from a national or regional wholesale distributor licensed in this state.
Source: SL 2023, ch 166, §15.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-18 - Duties--Pharmacy benefit manager.

58-29E-18. Duties--Pharmacy benefit manager.
A pharmacy benefit manager shall:
(1)Provide each pharmacy in a pharmacy network with reasonable access to each maximum allowable cost list to which the pharmacy is subject;
(2)Update a maximum allowable cost list, within seven calendar days from the date of any increase, at or above ten percent, in the price charged for a prescription drug on the list by one or more wholesale distributors doing business in this state;
(3)Update the maximum allowable cost list, within seven calendar days from the date of any change in the methodology, or any change in the value of a variable applied in the methodology, on which the maximum allowable cost list is based; and
(4)Provide a process under which each pharmacy in a pharmacy network may receive prompt notice of any change in a maximum allowable cost list to which the pharmacy is subject.
Source: SL 2023, ch 166, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-19 - Reimbursement.

58-29E-19. Reimbursement.
A pharmacy benefit manager may not reimburse any pharmacy located in this state an amount that is less than that which the pharmacy benefit manager reimburses a pharmacy benefit manager affiliate for dispensing the same prescription drug as that dispensed by the pharmacy.
The reimbursement amount must be calculated on a per unit basis, using the same generic product identifier or generic code number.
Source: SL 2023, ch 166, §17.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-20 - Information to be disclosed--Division request.

58-29E-20. Information to be disclosed--Division request.
A pharmacy benefit manager licensed under this chapter shall, at the request of the Division of Insurance, provide:
(1)The amount charged or claimed by the pharmacy benefit manager, in a format that allows the division to identify all instances of spread pricing; and
(2)Information regarding a shared ownership interest by any person defined in §58-29E-1.
Source: SL 2023, ch 166, §18.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29E - Pharmacy Benefits Management › Section 58-29E-21 - Licensure--Denial--Failure to provide information.

58-29E-21. Licensure--Denial--Failure to provide information.
In addition to any grounds set forth in §58-29D-31, the director may deny a pharmacy benefit manager's application for an initial or a renewed license, and may suspend or revoke a pharmacy benefit manager's license, if the director determines that the pharmacy benefit manager, or an applicant for a license, failed to provide information as required by this chapter.
Source: SL 2023, ch 166, §19.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-1 - Pharmacy audit integrity program established.

58-29F-1. Pharmacy audit integrity program established.
The pharmacy audit integrity program is hereby established to provide standards for an audit of pharmacy records carried out by a pharmacy benefits manager or any entity that represents the pharmacy benefits manager.
Source:
SL 2013, ch 254, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-2 - Definitions.

58-29F-2. Definitions.
Term used in this chapter mean:
(1)"Entity," a pharmacy benefits manager or any person or organization that represents these companies, groups, or organizations in any capacity;
(2)"Plan sponsor," the employer in the case of an employee benefit plan established or maintained by a single employer or the employee organization in the case of a plan established or maintained by an employee organization, an association, joint board, trustee, committee, or other similar group that establishes or maintains the plan.
Source:
SL 2013, ch 254, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-3 - Time for disclosing proposed change in pharmacy audit terms.

58-29F-3. Time for disclosing proposed change in pharmacy audit terms.
The pharmacy benefits manager shall disclose an amendment to the pharmacy audit terms in a contract between a pharmacy and a pharmacy benefits manager to the pharmacy at least sixty days prior to the effective date of the proposed change.
Source:
SL 2013, ch 254, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-4 - Requirements for conducting pharmacy audit.

58-29F-4. Requirements for conducting pharmacy audit.
Unless otherwise prohibited by federal statutes or regulations, any entity conducting a pharmacy audit shall:
(1)Give a pharmacy a minimum fourteen days written notice before conducting initial on-site audit;
(2)Conduct an audit that involves clinical or professional judgment in consultation with a licensed pharmacist; and
(3)Audit each pharmacy under the same standards and parameters as other similarly situated pharmacies.
Source:
SL 2013, ch 254, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-5 - Audit terms.

58-29F-5. Audit terms.
Unless otherwise prohibited by federal statutes or regulations, for any entity conducting a pharmacy audit the following audit items apply:
(1)The period covered by the audit may not exceed twenty-four months from the date that the claim was submitted to or adjudicated by the entity, unless a longer period is required under state or federal law;
(2)If an entity uses random sampling as a method for selecting a set of claims for examination, the sample size shall be appropriate for a statistically reliable sample. Notwithstanding any other provision, the auditing entity shall provide the pharmacy a masked list that provides a prescription number or date range that the auditing entity is seeking to audit;
(3)An on-site audit may not take place during the first five business days of the months of December and January unless the pharmacy consents;
(4)An auditor may not enter any portion of the pharmacy area where patient-specific information is available unless escorted, and to the extent possible shall remain out of sight and hearing range of the pharmacy patients;
(5)Any recoupment may not be deducted against future remittances until final completion of any appeals process and both parties have received the results of the final audit;
(6)A pharmacy benefits manager may not require information to be written on a prescription unless the information is required to be written on the prescription by state or federal law. Recoupment may be assessed for items not written on the prescription if:
(a)Additional information is required in the provider manual; or
(b)The information is required by the Food and Drug Administration; or
(c)The information is required by the drug manufacturer's product safety program; and
(d)The information in subsections (a), (b), or (c) is not readily available for the auditor at the time of the audit;
(7)The auditing company or agent may not receive payment based on a percentage of the amount recovered. This section does not prevent the entity conducting the audit from charging or assessing the responsible party, directly or indirectly, based on amounts recouped if:
(a)The plan sponsor and the entity conducting the audit have a contract that explicitly states the percentage charge or assessment to the plan sponsor; and
(b)A commission to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped.
Source:
SL 2013, ch 254, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-6 - Recoupment or chargeback criteria.

58-29F-6. Recoupment or chargeback criteria.
For recoupment or chargeback, the following criteria apply:
(1)Audit parameters shall consider consumer-oriented parameters based on manufacturer listings;
(2)A pharmacy's usual and customary price for compounded medications is considered the reimbursable cost unless the pricing methodology is outlined in the provider contract;
(3)A finding of overpayment or underpayment can only be based on the actual overpayment or underpayment and not a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs;
(4)The entity conducting the audit may not use extrapolation in calculating the recoupment or penalties for audits unless required by state or federal law or regulation;
(5)Calculations of overpayments may not include dispensing fees unless:
(a)A prescription was not actually dispensed;
(b)The prescriber denied authorization;
(c)The prescription dispensed was a medication error by the pharmacy; or
(d)The identified overpayment is solely based on an extra dispensing fee;
(6)An entity may not consider any clerical or record-keeping error, such as a typographical error, scrivener's error, or computer error regarding a required document or record as fraud. However, such errors may be subject to recoupment;
(7)In the case of errors that have no actual financial harm to the patient or plan, the pharmacy benefits manager may not assess any chargebacks. Errors that are a result of the pharmacy's failing to comply with a formal corrective action plan may be subject to recovery; and
(8)Interest may not accrue during the audit period for either party. The audit period begins with the notice of the audit and ends with the final audit report.
Source:
SL 2013, ch 254, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-7 - Validation of pharmacy record and delivery.

58-29F-7. Validation of pharmacy record and delivery.
To validate the pharmacy record and delivery, the pharmacy may use authentic and verifiable statements or records including medication administration records of a nursing home, assisted living facility, hospital, physician, or other authorized practitioner or additional audit documentation parameters located in the provider manual. Any legal prescription that meets the requirements in this chapter may be used to validate claims in connection with prescriptions, refills, or changes in prescriptions, including medication administration records, faxes, e-prescriptions, or documented telephone calls from the prescriber or the prescriber's agents.
Source:
SL 2013, ch 254, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-8 - Preliminary and final audit reports.

58-29F-8. Preliminary and final audit reports.
A preliminary audit report shall be delivered to the pharmacy within sixty days after the conclusion of the audit. A pharmacy shall be allowed at least forty-five days following receipt of the preliminary audit, to provide documentation to address any discrepancy found in the audit. A final audit report shall be delivered to the pharmacy within one hundred twenty days after receipt of the preliminary audit report or final appeal, whichever is later. An entity shall remit any money due to a pharmacy or pharmacist as a result of an underpayment of a claim within forty-five days after the appeals process has been exhausted and the final audit report has been issued.
Source:
SL 2013, ch 254, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-10 - Plan sponsor.

58-29F-10. Plan sponsor.
If contractually required, an auditing entity shall provide a copy of the claims included in the audit to the plan sponsor, and any recouped money shall be returned to the plan sponsor.
Source:
SL 2013, ch 254, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-11 - Chapter not applicable to investigative audits.

58-29F-11. Chapter not applicable to investigative audits.
The provisions of this chapter do not apply to any investigative audit that involves fraud, willful misrepresentation, or on any audit completed by the State of South Dakota on health care programs operated by the state.
Source:
SL 2013, ch 254, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29F - Pharmacy Audit Integrity Program › Section 58-29F-12 - Civil action by pharmacy.

58-29F-12. Civil action by pharmacy.
In addition to the remedies otherwise provided for in this chapter, in chapter 58-29E, or under general South Dakota law, any pharmacy subject to an audit procedure may bring a civil action to enforce the provisions of this chapter and to seek damages from the pharmacy benefits manager and any person or organization representing the entity during the audit process for the violation of the provisions of this chapter.
Source:
SL 2013, ch 254, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 30 - Insurance Producers › Section 58-30-1.1 - "Excess business" defined.

58-30-1.1. Excess business defined.
Excess business is that portion of a risk which is in excess of the amount that an insurer then represented by the insurance producer will accept.
Source:
SL 1982, ch 365, §6; SL 2001, ch 286, §154.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 30 - Insurance Producers › Section 58-30-6 - Appointment of insurance producer by insurer--Filing with director--Statement of kinds of insurance to be transacted--Payment of fee--Reasons for denying appointment.

58-30-6. Appointment of insurance producer by insurer--Filing with director--Statement of kinds of insurance to be transacted--Payment of fee--Reasons for denying appointment.
The director may deny an appointment or withhold processing an appointment for reasons of protection of the public health, welfare, or safety including the following:
(1)The insurance producer to be appointed is not properly licensed; or
(2)A notice of hearing from the Division of Insurance seeking revocation or suspension of the insurance producer or insurer has been issued.
Source:
SL 1966, ch 111, ch 9, §20 (1); SL 1995, ch 289, §1; SL 2001, ch 286, §156.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 30 - Insurance Producers › Section 58-30-8.1 - Notice required for termination of agency contract for fire and casualty lines--Extension of coverage on previous policies.

58-30-8.1. Notice required for termination of agency contract for fire and casualty lines--Extension of coverage on previous policies.
No insurance company may terminate the agency contract of an insurance producer writing fire and casualty lines of insurance except upon ninety days' notice in writing given by the company to the insurance producer. The company shall, upon a terminated insurance producer's request, extend the coverage of any policy which has been written by the insurance producer in the company and which expires or has its anniversary date during the ninety-day period to the end of the ninety-day period if the insured pays the premium therefor. The company may terminate an insurance policy on its anniversary date if the anniversary date occurs after the expiration of the ninety-day period.
Source:
SL 1971, ch 271; SL 2001, ch 286, §158.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 30 - Insurance Producers › Section 58-30-8.2 - Notice requirements inapplicable to exclusive agencies or termination for cause.

58-30-8.2. Notice requirements inapplicable to exclusive agencies or termination for cause.
The provisions of §58-30-8.1 do not apply to those agency contracts in which the insurance producer agrees to represent exclusively one company or a group of companies under common management or to the termination of an insurance producer's contract for insolvency, abandonment, gross and willful misconduct, or failure to pay over to the company moneys due to the company after the insurance producer's receipt of a written demand therefor, or after revocation of the insurance producer's license by the director.
Source:
SL 1971, ch 271; SL 2001, ch 286, §159.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 30 - Insurance Producers › Section 58-30-9 - Rights of insurance producer following termination of appointment.

58-30-9. Rights of insurance producer following termination of appointment.
Following termination of an agency appointment as to property, casualty, or surety insurance, and subject to the terms of any agreement between the insurance producer and the insurer, the insurance producer may continue to service and receive from the insurer commissions or other compensation relative to business written by him the insurance producer during the existence of the appointment, so long as the insurance producer is licensed as an insurance producer.
Source:
SL 1966, ch 111, ch 9, §22 (1); SL 2001, ch 286, §160.