reglab/statecodes huggingface dataset:
2023 Utah Code › Title 31A - Insurance Code › Chapter 44 - Continuing Care Provider Act › Part 6 - Enforcement › Section 604 - Criminal and civil penalties.

Effective 5/10/2016
31A-44-604.
Criminal and civil penalties.
(1) A person who knowingly violates this chapter or files materially false information with a registration application or renewal under this chapter is:
(a) guilty of a class B misdemeanor; and
(b) subject to revocation of the person's registration under this chapter.
(2) Subject to Title 63G, Chapter 4, Administrative Procedures Act, if the department determines that a person is engaging in the business of being a continuing care provider in violation of this chapter, the department may:
(a) suspend, revoke, or refuse to renew the person's registration under this chapter;
(b) issue a cease and desist order from committing any further violation;
(c) prohibit the person from continuing to engage in the business of being a continuing care provider;
(d) impose an administrative fine not greater than $1,000 per violation, except that the aggregate total of fines imposed under this chapter against a person in a calendar year may not exceed $30,000 for that calendar year; or
(e) take any combination of actions listed under this Subsection (2).
(3) If the department revokes a registration, the department is not required to refund any portion of the provider's filing or renewal fee for the remainder of the period for which the fee is paid.
Enacted by Chapter 270, 2016 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 44 - Continuing Care Provider Act › Part 6 - Enforcement › Section 605 - Civil liability.

Effective 7/17/2016
31A-44-605.
Civil liability.
(1) A provider who enters into a continuing care contract with an individual without complying with the disclosure statement requirement described in this chapter, or who makes a continuing care contract with an individual who relies on a disclosure statement that misstates or omits a material fact, is liable to the individual for:
(a) actual damages;
(b) repayment of all fees the individual paid to the provider, minus the reasonable value of care and lodging provided to the individual before the violation, misstatement, or omission was discovered or reasonably should have been discovered;
(c) interest at the legal rate for judgments;
(d) court costs; and
(e) reasonable attorney fees.
(2) A provider is liable under this section unless the provider proves by a preponderance of evidence that the provider and the provider's agents and employees did not know and should not have known of the misstatement or omission.
(3) An individual may not maintain an action under this section if:
(a) the individual receives a written offer from the provider for refund of all amounts paid to the provider or the provider's facility plus reasonable interest from the date of payment, minus the reasonable value of care and lodging provided before the receipt of the offer;
(b) the individual receives the offer described in Subsection (3)(a) before a day that is 30 days after the earlier of:
(i) the day on which the individual submits a written request to the provider for repayment under this section; or
(ii) the day on which the individual files an action under this section;
(c) the offer includes a description of the provisions of this section; and
(d) the recipient of the offer fails to accept the offer within 30 days after the date the offer is received.
(4) An individual shall bring an action under this section before the day three years after:
(a) the day on which the individual enters into the continuing care contract; or
(b) the individual discovers, or reasonably should have discovered, the provider's violation, misstatement, or omission.
(5) A person does not have a cause of action under this chapter except as expressly provided by this chapter.
(6) This chapter does not limit the liability that exists under any other statute or common law.
(7) The provisions of this chapter are not exclusive and the remedies provided by this chapter are in addition to any other remedies provided by any other law.
Amended by Chapter 8, 2016 Special Session 3
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 1 - General Provisions › Section 102 - Definitions.

Effective 5/14/2019
31A-45-102.
Definitions.
As used in this chapter:
(1) "Covered benefit" or "benefit" means the health care services to which a covered person is entitled under the terms of a health care insurance plan offered by a managed care organization.
(2) "Managed care organization" means:
(a) a managed care organization as that term is defined in Section 31A-1-301; and
(b) a third party administrator as that term is defined in Section 31A-1-301.
Amended by Chapter 193, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 1 - General Provisions › Section 103 - Managed care contract standards.

Effective 1/1/2018
31A-45-103.
Managed care contract standards.
The commissioner shall adopt rules relating to standards for the manner and content of policy provisions, and disclosures to be made in connection with the sale of policies covered by this chapter, dealing with at least the following matters:
(1) terms of renewability;
(2) initial and subsequent conditions of eligibility;
(3) nonduplication of coverage provisions;
(4) coverage of dependents;
(5) termination of insurance;
(6) limitations;
(7) exceptions;
(8) reductions;
(9) definition of terms; and
(10) rating practices.
Enacted by Chapter 292, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 2 - Applicability to Other Provisions of Law › Section 201 - Applicability to other provisions of law -- Commissioner discretion.

Effective 1/1/2018
31A-45-201.
Applicability to other provisions of law -- Commissioner discretion.
(1) Except for exemptions specifically granted under this title, a managed care organization is subject to regulation under all of the provisions of this title.
(2) The commissioner may by rule waive other specific provisions of this title that the commissioner considers inapplicable to managed care organizations, upon a finding that the waiver will not endanger the interests of:
(a) enrollees;
(b) investors;
(c) the public; or
(d) health care providers.
Enacted by Chapter 292, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 3 - Relationships with Providers › Section 302 - Provider payment information -- Notice of admissions.

Effective 1/1/2018
31A-45-302.
Provider payment information -- Notice of admissions.
(1)
(a) A managed care organization shall provide the managed care organization's network providers access to current information necessary for the network provider to determine:
(i) the effect of procedure codes on payment or compensation before a claim is submitted for a procedure;
(ii) the plans and carrier networks that the network provider is subject to as part of the contract with the managed care organization; and
(iii) in accordance with Subsection 31A-26-301.6(10)(f), the specific rate and terms under which the network provider will be paid for health care services.
(b) The information required by Subsection (1)(a) may be provided through a website, and if requested by the network provider, notice of the updated website shall be provided by the managed care organization.
(2)
(a) A managed care organization may not require a health care provider by contract, reimbursement procedure, or otherwise to notify the managed care organization of a hospital inpatient emergency admission within a period of time that is less than one business day of the hospital inpatient admission, if compliance with the notification requirement would result in notification by the health care provider on a weekend or federal holiday.
(b) Subsection (2)(a) does not prohibit the applicability or administration of other contract provisions between a managed care organization and a network provider that require preauthorization for scheduled inpatient admissions.
Enacted by Chapter 292, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 3 - Relationships with Providers › Section 305 - Prohibition on certain age-based physician testing.

Effective 5/14/2019
31A-45-305.
Prohibition on certain age-based physician testing.
A managed care organization or other third party may not require for purposes of reimbursement that a physician, as defined in Section 58-67-102, take a cognitive test when the physician reaches a specified age, unless the test reflects the standards described in Subsections 58-67-302(5)(b)(i) through (x).
Amended by Chapter 445, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 4 - Access to Services for Managed Care Enrollees › Section 401 - Court ordered coverage for minor children who reside outside the service area.

Effective 5/14/2019
31A-45-401.
Court ordered coverage for minor children who reside outside the service area.
(1)
(a) The requirements of Subsection (2) apply to a managed care organization if the managed care organization:
(i) restricts coverage for nonemergency services to services provided by contracted providers within the organization's service area; and
(ii) does not offer a benefit that permits members the option of obtaining covered services from a non-network provider.
(b) The requirements of Subsection (2) do not apply to a managed care organization if:
(i) the child is no longer the subject of a court or administrative support order; or
(ii) a parent's employer offers the parent a choice to select health insurance coverage that is not a managed care organization plan either at the time of the court or administrative support order, or at a subsequent open enrollment period. This exemption from Subsection (2) applies even if the parent ultimately chooses the managed care organization plan.
(2) If a parent is required by a court or administrative support order to provide health insurance coverage for a child who resides outside of a managed care organization's service area, the managed care organization shall:
(a) comply with the provisions of Section 31A-22-610.5;
(b) allow the enrollee parent to enroll the child on the organization plan;
(c) pay for otherwise covered health care services rendered to the child outside of the service area by a non-network provider:
(i) if the child, noncustodial parent, or custodial parent has complied with prior authorization or utilization review otherwise required by the organization; and
(ii) in an amount equal to the dollar amount the organization pays under a noncapitated arrangement for comparable services to a network provider in the same class of health care providers as the provider who rendered the services; and
(d) make payments on claims submitted in accordance with Subsection (2)(c) directly to the provider, custodial parent, the child who obtained benefits, or state Medicaid agency.
(3)
(a) The parents of the child who is the subject of the court or administrative support order are responsible for any charges billed by the provider in excess of those paid by the organization.
(b) This section does not affect any court or administrative order regarding the responsibilities between the parents to pay any medical expenses not covered by accident and health insurance or a managed care organization plan.
(4) The commissioner shall adopt rules as necessary to administer this section and Section 31A-22-610.5.
Amended by Chapter 193, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 4 - Access to Services for Managed Care Enrollees › Section 402 - Alcohol and drug dependency treatment.

Effective 5/3/2023
31A-45-402.
Alcohol and drug dependency treatment.
(1) A managed care organization offering a health benefit plan providing coverage for alcohol or drug dependency treatment may require an inpatient facility to be licensed by:
(a)
(i) the Department of Health and Human Services, under Title 26B, Chapter 2, Part 1, Human Services Programs and Facilities; or
(ii) the Department of Health and Human Services; or
(b) for an inpatient facility located outside the state, a state agency similar to one described in Subsection (1)(a).
(2) For inpatient coverage provided pursuant to Subsection (1), a managed care organization may require an inpatient facility to be accredited by the following:
(a) the Joint Commission; and
(b) one other nationally recognized accrediting agency.
Amended by Chapter 328, 2023 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 45 - Managed Care Organizations › Part 4 - Access to Services for Managed Care Enrollees › Section 403 - Essential health benefits.

Effective 5/8/2018
31A-45-403.
Essential health benefits.
(1) The state designates the state's own essential health benefits and does not accept a federal determination of the essential health benefits under the PPACA.
(2) Subject to Subsections (3) and (4), the commissioner shall make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, that designate the essential health benefits for the state.
(3) Before the commissioner makes rules in accordance with Subsection (2):
(a) the commissioner shall present a summary of the commissioner's planned rules to the Health Reform Task Force; and
(b) the Health Reform Task Force shall recommend whether the commissioner makes rules in accordance with the presented summary.
(4) The essential health benefits plan:
(a) may not include a state mandate if the inclusion of the state mandate would require the state to contribute to premium subsidies under the PPACA; and
(b) may add benefits in addition to the benefits included in a benchmark plan adopted in accordance with this section if the additional benefits are mandated under the PPACA.
Enacted by Chapter 319, 2018 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 2 - Licensure › Section 201 - License required.

Effective 7/1/2019
31A-46-201.
License required.
(1) A person may not perform, offer to perform, or advertise any pharmacy benefits management service in the state unless the person is licensed as a pharmacy benefit manager under this chapter.
(2) A person may not utilize the services of another person as a pharmacy benefit manager if the person knows or has reason to know that the other person does not have a license under this chapter.
Enacted by Chapter 241, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 2 - Licensure › Section 202 - Application for licensure.

Effective 7/1/2019
31A-46-202.
Application for licensure.
(1) To obtain or renew a license as a pharmacy benefit manager, a person shall:
(a) submit an application to the commissioner on forms and in a manner established by the commissioner by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and
(b) pay a licensure fee established by the department in accordance with Section 31A-3-103.
(2)
(a) The commissioner may require an applicant to submit information or documentation regarding the management and ownership of the pharmacy benefit manager in the application described in Subsection (1)(a).
(b) Any material change in the information submitted in an application described in Subsection (1)(a) shall be reported to the department within 30 days after the day on which the information changes.
(3) The term of a license issued under this section is one year.
Enacted by Chapter 241, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 301 - Reporting requirements.

Effective 5/12/2020
31A-46-301.
Reporting requirements.
(1) Before April 1 of each year, a pharmacy benefit manager operating in the state shall report to the department, for the previous calendar year:
(a) any insurer, pharmacy, or pharmacist in the state with which the pharmacy benefit manager had a contract;
(b) the total value, in the aggregate, of all rebates and administrative fees that are attributable to enrollees of a contracting insurer; and
(c) if applicable, the percentage of aggregate rebates that the pharmacy benefit manager retained under the pharmacy benefit manager's agreement to provide pharmacy benefits management services to a contracting insurer.
(2) Records submitted to the commissioner under Subsections (1)(b) and (c) are a protected record under Title 63G, Chapter 2, Government Records Access and Management Act.
(3)
(a) The department shall publish the information provided by a pharmacy benefit manager under Subsection (1)(c) in the annual report described in Section 31A-2-201.2.
(b) The department may not publish information submitted under Subsection (1)(b) or (c) in a manner that:
(i) makes a specific submission from a contracting insurer or pharmacy benefit manager identifiable; or
(ii) is likely to disclose information that is a trade secret as defined in Section 13-24-2.
(c) At least 30 days before the day on which the department publishes the data, the department shall provide a pharmacy benefit manager that submitted data under Subsection (1)(b) or (c) with:
(i) a general description of the data that will be published by the department;
(ii) an opportunity to submit to the department, within a reasonable period of time and in a manner established by the department by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act:
(A) any correction of errors, with supporting evidence and comments; and
(B) information that demonstrates that the publication of the data will violate Subsection (3)(b), with supporting evidence and comments.
Amended by Chapter 198, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 303 - Insurer and pharmacy benefit management services -- Registration -- Maximum allowable cost -- Audit restrictions.

Effective 5/12/2020
31A-46-303.
Insurer and pharmacy benefit management services -- Registration -- Maximum allowable cost -- Audit restrictions.
(1) An insurer and an insurer's pharmacy benefit manager is subject to the pharmacy audit provisions of Section 58-17b-622.
(2) A pharmacy benefit manager shall not use maximum allowable cost as a basis for reimbursement to a pharmacy unless:
(a) the drug is listed as "A" or "B" rated in the most recent version of the United States Food and Drug Administration's approved drug products with therapeutic equivalent evaluations, also known as the "Orange Book," or has an "NR" or "NA" rating or similar rating by a nationally recognized reference; and
(b) the drug is:
(i) generally available for purchase in this state from a national or regional wholesaler; and
(ii) not obsolete.
(3) The maximum allowable cost may be determined using comparable and current data on drug prices obtained from multiple nationally recognized, comprehensive data sources, including wholesalers, drug file vendors, and pharmaceutical manufacturers for drugs that are available for purchase by pharmacies in the state.
(4) For every drug for which the pharmacy benefit manager uses maximum allowable cost to reimburse a contracted pharmacy, the pharmacy benefit manager shall:
(a) include in the contract with the pharmacy information identifying the national drug pricing compendia and other data sources used to obtain the drug price data;
(b) review and make necessary adjustments to the maximum allowable cost, using the most recent data sources identified in Subsection (4)(a), at least once per week;
(c) provide a process for the contracted pharmacy to appeal the maximum allowable cost in accordance with Subsection (5); and
(d) include in each contract with a contracted pharmacy a process to obtain an update to the pharmacy product pricing files used to reimburse the pharmacy in a format that is readily available and accessible.
(5)
(a) The right to appeal in Subsection (4)(c) shall be:
(i) limited to 21 days following the initial claim adjudication; and
(ii) investigated and resolved by the pharmacy benefit manager within 14 business days.
(b) If an appeal is denied, the pharmacy benefit manager shall provide the contracted pharmacy with the reason for the denial and the identification of the national drug code of the drug that may be purchased by the pharmacy at a price at or below the price determined by the pharmacy benefit manager.
(6) The contract with each pharmacy shall contain a dispute resolution mechanism in the event either party breaches the terms or conditions of the contract.
(7) This section does not apply to a pharmacy benefit manager when the pharmacy benefit manager is providing pharmacy benefit management services on behalf of the Medicaid program.
Amended by Chapter 198, 2020 General Session
Amended by Chapter 275, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 304 - Claims practices.

Effective 5/12/2020
31A-46-304.
Claims practices.
(1) A pharmacy benefit manager shall permit a pharmacy to collect the amount of a customer's cost share from any source.
(2) A pharmacy benefit manager may not deny or reduce a reimbursement to a pharmacy or a pharmacist after the adjudication of the claim, unless:
(a) the pharmacy or pharmacist submitted the original claim fraudulently;
(b) the original reimbursement was incorrect because:
(i) the pharmacy or pharmacist had already been paid for the pharmacy service; or
(ii) an unintentional error resulted in an incorrect reimbursement; or
(c) the pharmacy service was not rendered by the pharmacy or pharmacist.
(3) Subsection (2) does not apply if:
(a) any form of an investigation or audit of pharmacy records for fraud, waste, abuse, or other intentional misrepresentation indicates that the pharmacy or pharmacist engaged in criminal wrongdoing, fraud, or other intentional misrepresentation; or
(b) the reimbursement is reduced as the result of the reconciliation of a reimbursement amount under a performance contract if:
(i) the performance contract lays out clear performance standards under which the reimbursement for a specific drug may be increased or decreased; and
(ii) the agreement between the pharmacy benefit manager and the pharmacy or pharmacist explicitly states, in a separate document that is signed by the pharmacy benefit manager and the pharmacy or pharmacist, that the provisions of Subsection (2) do not apply.
Amended by Chapter 198, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 305 - Pharmacy reimbursement.

Effective 5/12/2020
31A-46-305.
Pharmacy reimbursement.
A pharmacy benefit manager shall reimburse a network pharmacy, in the aggregate, in an amount no less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benefit manager in the same network, in the aggregate, for providing the same or equivalent pharmacy service.
Enacted by Chapter 198, 2020 General Session
This was also enacted in HB272, Chapter 198 and SB138, Chapter 275, however, this section number will not be updated and will remain as 58-17b-619.
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 306 - Mailing or delivering prescription drugs.

Effective 5/12/2020
31A-46-306.
Mailing or delivering prescription drugs.
A pharmacy benefit manager or an insurer may not, directly or indirectly:
(1) prohibit an in-network retail pharmacy from:
(a) mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network retail pharmacy;
(b) charging a shipping or handling fee to an enrollee who requests that the in-network retail pharmacy mail or deliver a prescription drug to the enrollee, as an ancillary service; or
(c) offering or soliciting the ancillary services described in Subsection (1)(a) to an enrollee; or
(2) charge an enrollee who uses an in-network retail pharmacy that offers to mail or deliver a prescription drug to an enrollee as an ancillary service a fee or copayment that is higher than the fee or copayment the enrollee would pay if the enrollee used an in-network retail pharmacy that does not offer to mail or deliver a prescription drug to an enrollee as an ancillary service.
Enacted by Chapter 198, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 307 - Pharmacy benefit manager reporting.

Effective 5/12/2020
31A-46-307.
Pharmacy benefit manager reporting.
(1) A pharmacy benefit manager may not enter into or renew a contract with an insurer on or after January 1, 2021, to administer or manage rebate contracting or rebate administration unless the pharmacy benefit manager agrees to regularly report to the insurer information regarding pharmaceutical manufacturer rebates received by the pharmacy benefit manager under the contract.
(2) The quality and type of information required under Subsection (1) shall be detailed, claims level information unless the pharmacy benefit manager and insurer agree to waive this requirement in a separate written agreement.
Enacted by Chapter 198, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 308 - Out-of-state mail service pharmacies -- Drugs not readily available in all pharmacies.

Effective 5/12/2020
31A-46-308.
Out-of-state mail service pharmacies -- Drugs not readily available in all pharmacies.
(1) As used in this section, "out-of-state mail service pharmacy" means the same as that term is defined in Section 58-17b-102.
(2) Except as provided in Subsection (3), a third party payor of pharmaceutical services within the state, or its agent or contractor, may not require a pharmacy patient to obtain prescription drug benefits from one or more out-of-state mail service pharmacies as a condition of obtaining third party payment prescription drug benefit coverage as defined in rule.
(3) For a prescription drug or device that is not readily available in all pharmacies, including an injectable medication, a third party payor of pharmaceutical services may require a pharmacy patient to obtain prescription drug benefits from certain pharmacies, including one or more out-of-state mail service pharmacies.
(4)
(a) A violation of this section is a class A misdemeanor.
(b) Each violation of this section is a separate offense.
Renumbered and Amended by Chapter 198, 2020 General Session
Renumbered and Amended by Chapter 372, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 309 - Reimbursement -- Prohibitions.

Effective 5/12/2020
31A-46-309.
Reimbursement -- Prohibitions.
(1) This section applies to a contract entered into or renewed on or after January 1, 2021, between a pharmacy benefit manager and a pharmacy.
(2) A pharmacy benefit manager may not vary the amount it reimburses a pharmacy for a drug on the basis of whether:
(a) the drug is a 340B drug; or
(b) the pharmacy is a 340B entity.
(3) Subsection (2) does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.
(4) A pharmacy benefit manager may not:
(a) on the basis that a 340B entity participates, directly or indirectly, in the 340B drug discount program:
(i) assess a fee, charge-back, or other adjustment on the 340B entity;
(ii) restrict access to the pharmacy benefit manager's pharmacy network;
(iii) require the 340B entity to enter into a contract with a specific pharmacy to participate in the pharmacy benefit manager's pharmacy network;
(iv) create a restriction or an additional charge on a patient who chooses to receive drugs from a 340B entity; or
(v) create any additional requirements or restrictions on the 340B entity; or
(b) require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program.
Enacted by Chapter 275, 2020 General Session
Technically renumbered to avoid duplication of section number also enacted in HB272, Chapter 198.
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 3 - Operating Requirements › Section 310 - Prohibited actions with respect to a federally qualified health center.

Effective 5/5/2021
31A-46-310.
Prohibited actions with respect to a federally qualified health center.
(1) As used in this section, "federally qualified health center":
(a) means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and
(b) includes the pharmacy or pharmacies that are operated by or contract with a federally qualified health center described in Subsection (1)(a) to dispense drugs purchased through the federally qualified health center.
(2) This section applies to a contract entered into or renewed on or after January 1, 2022, between an insurer and a pharmacy described in Subsection (1)(b).
(3) An insurer may not vary the amount that the insurer reimburses to a federally qualified health center for a drug on the basis of whether:
(a) the drug is a 340B drug; or
(b) the pharmacy is a 340B entity.
(4) Subsection (3) does not apply to a drug reimbursed, directly or indirectly, by the Medicaid program.
(5) An insurer or an insurer's pharmacy service entity may not:
(a) on the basis that a federally qualified health center participates, directly or through a contractual arrangement, in the 340B drug discount program:
(i) assess a fee, charge-back, or other adjustment on a federally qualified health center;
(ii) restrict access to the insurer's pharmacy network;
(iii) require the federally qualified health center to enter into a contract with a specific pharmacy to participate in the insurer's pharmacy network;
(iv) create a restriction or an additional charge on a patient who chooses to receive drugs from a federally qualified health center; or
(v) create any additional requirements or restrictions on the federally qualified health center; or
(b) require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program.
Enacted by Chapter 317, 2021 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 4 - Miscellaneous › Section 401 - Penalties.

Effective 7/1/2019
31A-46-401.
Penalties.
A person that violates a provision of this chapter is subject to the penalties described in Section 31A-2-308.
Enacted by Chapter 241, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 46 - Pharmacy Benefits Act › Part 4 - Miscellaneous › Section 402 - Severability.

Effective 7/1/2019
31A-46-402.
Severability.
If any provision of this chapter or the application of any provision of this chapter is found invalid, the remainder of this chapter shall be given effect without the invalid provision or application.
Enacted by Chapter 241, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 48 - Prescription Drug Price Transparency Act › Section 101 - Title.

Effective 5/12/2020
31A-48-101.
Title.
This chapter is known as "Prescription Drug Price Transparency Act."
Enacted by Chapter 198, 2020 General Session
Technically renumbered to avoid duplication of section number also enacted in HB402, Chapter 141.
2023 Utah Code › Title 31A - Insurance Code › Chapter 48 - Prescription Drug Price Transparency Act › Section 102 - Definitions.

Effective 5/4/2022
31A-48-102.
Definitions.
As used in this chapter:
(1)
(a) "Drug" means a substance that is:
(i)
(A) intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans; and
(B) recognized in or in a supplement to the official United States Pharmacopoeia, the Homeopathic Pharmacopoeia of the United States, or the official National Formulary;
(ii) required by an applicable federal or state law or rule to be dispensed by prescription only;
(iii) restricted to administration by practitioners only;
(iv) a substance other than food intended to affect the structure or a function of the human body; or
(v) intended for use as a component of a substance described in Subsection (1)(a)(i), (ii), (iii), or (iv).
(b) "Drug" does not include a dietary supplement.
(2) "Insurer" means the same as that term is defined in Section 31A-22-634.
(3) "Manufacturer" means a person that is engaged in the manufacturing of a drug that is available for purchase by residents of the state.
(4) "Rebate" means the same as that term is defined in Section 31A-46-102.
(5) "Wholesale acquisition cost" means the same as that term is defined in 42 U.S.C. Sec. 1395w-3a.
Amended by Chapter 198, 2022 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 1 - General Provisions › Section 101 - Title.

32B-1-101.
Title.
(1) This title is known as the "Alcoholic Beverage Control Act."
(2) This chapter is known as "Alcoholic Beverage Control General Provisions."
Enacted by Chapter 276, 2010 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 1 - General Provisions › Section 103 - Policy.

32B-1-103.
Policy.
The policies of the state are as follows:
(1) This title shall be administered in a manner that is nonpartisan and free of partisan political influence.
(2) Alcoholic product control shall be operated as a public business using sound management principles and practices. This public business shall:
(a) be governed by a commission;
(b) be operated by a department; and
(c) function with the intent of servicing the public demand for alcoholic products.
(3) The commission and department may not promote or encourage the sale or consumption of alcoholic products.
(4) The commission shall conduct, license, and regulate the sale of alcoholic products in a manner and at prices that:
(a) reasonably satisfy the public demand and protect the public interest, including the rights of citizens who do not wish to be involved with alcoholic products; and
(b) will promote the reduction of the harmful effects of:
(i) overconsumption of alcoholic products by adults; and
(ii) consumption of alcoholic products by minors.
Enacted by Chapter 276, 2010 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 1 - General Provisions › Section 104 - Exercise of police powers -- Severability.

Effective 5/9/2017
32B-1-104.
Exercise of police powers -- Severability.
(1)
(a) This title is an exercise of the police powers of the state for the protection of the public health, peace, safety, welfare, and morals, and regulates the storage, sale, offer for sale, furnishing, consumption, manufacture, and distribution of an alcoholic product.
(b) This title governs alcoholic product control unless otherwise provided in this title.
(2)
(a) A licensee or permittee has the rights and privileges described in this title that are applicable to the licensee's or permittee's license or permit.
(b) A licensee or permittee may engage in an activity related to the storage, sale, offer for sale, furnishing, consumption, manufacture, or distribution of an alcoholic product only if the activity is expressly permitted under this title or a rule authorized under this title and made by the commission.
(3) The department and the commission:
(a) shall implement and enforce the provisions of this title in accordance with the express language of the provisions of this title and in a manner consistent with the policy described in Section 32B-1-103; and
(b) may not waive any provision of this title.
(4) If a provision of this title or the application of a provision to a person or circumstance is held invalid, the remainder of this title shall be given effect without the invalid provision or application. The provisions of this title are severable.
Amended by Chapter 455, 2017 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 202.1 - Proximity for certain and arena hotel licensees.

Effective 5/3/2023
32B-1-202.1.
Proximity for certain hotel and arena licensees.
(1) As used in this section, "hotel" means the same as that term is defined in Section 32B-8b-102.
(2) The commission may issue a hotel license for a proposed location that does not meet the proximity requirements under Section 32B-1-202, if:
(a) the proposed hotel is:
(i) located in a city classified as a city of the first class under Section 10-2-301;
(ii) within 650 feet of two community locations, as measured from the nearest patron entrance of the proposed hotel by following the shortest route of ordinary pedestrian travel to the property boundary of each community location;
(iii) not within 300 feet of a community location, as measured from the nearest patron entrance of the proposed hotel by following the shortest route of ordinary pedestrian travel to the property boundary of the community location; and
(iv) not within 200 feet of a community location, as measured in a straight line from the nearest patron entrance of the proposed hotel to the nearest property boundary of the community location;
(b) the proposed sublicensed premises of a bar establishment sublicense under the hotel license:
(i) is on the second or higher floor of a hotel;
(ii) is not accessible at street level; and
(iii) is only accessible to an individual who passes through another area of the hotel in which the bar establishment sublicense is located; and
(c) the applicant meets all other criteria under this title for the hotel license.
(3) The commission may issue authority to operate as a package agency to a hotel licensee who meets the requirements described in Subsection (2).
(4)
(a) The commission may issue an arena license for a proposed location that does not meet the proximity requirements described in Section 32B-1-202, if, on the day before the day on which the commission issues the license, each proposed sublicense of the arena license:
(i) operates as an outlet or restaurant; and
(ii)
(A) operates on the proposed sublicense premises under a variance to one or more proximity requirements in accordance with Section 32B-1-202; or
(B) has been in operation on the proposed sublicense premises for at least 10 years.
(b) After the commission issues an arena license in accordance with Subsection (4)(a), the commission may not issue the arena licensee an additional sublicense.
Amended by Chapter 371, 2023 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 203 - Licensee compliance with other laws.

32B-1-203.
Licensee compliance with other laws.
(1) A licensee and a person applying for a license shall comply with the applicable federal and state laws pertaining to payment of taxes and contributions to unemployment and insurance funds to which the licensee or person may be subject.
(2) The commission:
(a) may not issue a license to a person who violates this section; and
(b) may suspend, revoke, or not renew the license of a licensee who violates this section.
Amended by Chapter 307, 2011 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 204 - Powers of local authority.

32B-1-204.
Powers of local authority.
(1) If this title expressly addresses an issue related to alcoholic product control in this state, a local authority may not regulate in relation to that issue except when a local authority is expressly granted regulatory authority to regulate the issue by this title.
(2) If this title does not expressly address an issue related to alcoholic product control, a local authority may regulate that issue if the regulation:
(a) is of the sale, offer for sale, furnishing, or consumption of an alcoholic product; and
(b) does not conflict with this title.
Enacted by Chapter 276, 2010 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 205 - Falsifying or taking other actions with records prohibited.

32B-1-205.
Falsifying or taking other actions with records prohibited.
(1) A person required to make or maintain a record under this title or rules of the commission, or a person acting for that person, may not knowingly forge, falsify, alter, cancel, destroy, conceal, or remove the record for the purpose of deceiving the commission, a commissioner, the director, the department, a department employee, or a law enforcement officer.
(2) A violation of this section may result in:
(a) disciplinary action in accordance with Chapter 3, Disciplinary Actions and Enforcement Act, if the person who violates this section is a person subject to administrative action; or
(b) criminal prosecution if the violation is a criminal offense under Chapter 4, Criminal Offenses and Procedure Act.
Enacted by Chapter 276, 2010 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 206 - Advertising prohibited -- Exceptions.

Effective 5/3/2023
32B-1-206.
Advertising prohibited -- Exceptions.
(1)
(a) The department may not advertise liquor, except:
(i) the department may provide for an appropriate sign in the window or on the front of a state store or package agency denoting that it is a state authorized liquor retail facility;
(ii) the department or a package agency may provide a printed price list to the public;
(iii) the department may authorize the use of price posting and floor stacking of liquor within a state store;
(iv) subject to Subsection (1)(b), the department may provide a listing of the address and telephone number of a state store in one or more printed or electronic directories available to the general public; and
(v) subject to Subsection (1)(b), a package agency may provide a listing of its address and telephone number in one or more printed or electronic directories available to the general public.
(b) A listing under Subsection (1)(a)(iv) or (v) in the business or yellow pages of a telephone directory may not be displayed in an advertisement or other promotional format.
(2)
(a) The department may not advertise an alcoholic product on a billboard.
(b) A package agency may not advertise an alcoholic product on a billboard, except to the extent allowed by the commission by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
(3)
(a) The department may not display liquor or a price list in a window or showcase visible to passersby.
(b) A package agency may not display liquor or a price list in a window or showcase visible to passersby, except to the extent allowed by the commission by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
(4) A public transit district, as defined in Section 17B-2a-802, may not allow advertising on a transit vehicle, as defined in Section 17B-2a-802, that promotes an alcoholic product.
(5) Advertising of an alcoholic product may not:
(a) promote the intoxicating effects of alcohol; or
(b) emphasize the high alcohol content of the alcoholic product.
(6) Except to the extent prohibited by this title, the advertising of an alcoholic product is allowed under guidelines established by the commission by rule.
(7) The advertising or use of any means or media to offer an alcoholic product to the general public without charge is prohibited.
Amended by Chapter 371, 2023 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 207 - Calculation of ratio of gross receipts of food to alcoholic product.

Effective 5/5/2021
32B-1-207.
Calculation of ratio of gross receipts of food to alcoholic product.
In calculating the annual gross receipts of a retail license or sublicense for purposes of determining the percentage of gross receipts from the sale, offer for sale, or furnishing of food or an alcoholic product, a retail licensee may not include in the calculation the money from the sale of:
(1) a bottle of wine by the retail licensee or under a sublicense that is in excess of $175;
(2) an individual portion of wine, as described in Subsection 32B-5-304(2)(a), by the retail licensee or under a sublicense that is in excess of $30; or
(3) an individual portion of spirituous liquor, as described in Subsection 32B-5-304(1), by the retail licensee or under a sublicense that is in excess of $30.
Amended by Chapter 291, 2021 General Session
2023 Utah Code › Title 32B - Alcoholic Beverage Control Act › Chapter 1 - Alcoholic Beverage Control General Provisions › Part 2 - Miscellaneous Provisions › Section 208 - Percentage lease agreements.

Effective 6/25/2020
32B-1-208.
Percentage lease agreements.
(1) As used in this section:
(a) "Percentage lease agreement" means a lease agreement in which the lessee:
(i) is a retail licensee; and
(ii) pays the lessor:
(A) a base rent; and
(B) percentage rent.
(b) "Percentage rent" means a percentage:
(i) agreed upon between a lessor and lessee; and
(ii) of the total sales revenue that:
(A) exceed a fixed dollar amount of sales revenue; and
(B) the lessee earns while doing business on the rental premises.
(2)
(a) The parties to a percentage lease agreement shall submit a copy of the percentage lease agreement to the department.
(b) If there is a material change to the percentage lease agreement submitted to the department under Subsection (2)(a), the parties to the percentage lease agreement shall promptly submit a copy of the changed percentage lease agreement to the department.
(3) If a percentage lease agreement requires a retail licensee to pay the lessor a percentage rent of 6% or less, the department may not conduct any further investigation into the percentage lease agreement.
(4) The commission shall make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing:
(a) the maximum percentage of revenue from alcohol sales a percentage lease agreement may require; and
(b) the procedure for submitting a percentage lease agreement under Subsection (2).
(5)
(a) The provisions of this section do not apply to a percentage lease agreement in which the lessee is an airport lounge licensee.
(b) Nothing in this title prohibits an airport lounge licensee from entering into a percentage lease agreement, regardless of the percentage rent specified in the percentage lease agreement.
Amended by Chapter 3, 2020 Special Session 5