(a) To place a drug on a maximum allowable cost list, a pharmacy benefit manager must ensure that the drug meets the following requirements:
(1) It is listed as “A” or “B” rated in the most recent version of the FDA’s Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book, or has an “NR” or “NA” rating or a similar rating by a nationally recognized reference.
(2) It is generally available for purchase by pharmacies in the state from national or regional wholesalers.
(3) It is not obsolete.
(b) A pharmacy benefit manager engaging in maximum allowable cost pricing must:
(1) Make available to each network provider at the beginning of the term of the network provider’s contract, and upon renewal of the contract, the sources utilized to determine the maximum allowable cost pricing;
(2) Provide a process for network pharmacy providers to readily access the maximum allowable cost specific to that provider;
(3) Review and update maximum allowable cost price information at least once every 7 business days and update the information when there is a modification of maximum allowable cost pricing; and
(4) Ensure that dispensing fees are not included in the calculation of maximum allowable cost.
80 Del. Laws, c. 245, § 1.
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