Requirements for use of the National Drug Code by a pharmacy benefit manager

A. Before a pharmacy benefit manager places or continues a particular NDC or Maximum Allowable Cost List, the following requirements shall be met: (1) The prescription drug to which the NDC is assigned shall be 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 have an "NR" or "NA" rating or a similar rating by a nationally recognized reference. (2) The prescription drug to which the NDC is assigned shall be available for purchase by pharmacies in the state from national or regional wholesalers. (3) The prescription drug to which the NDC is assigned shall not be considered obsolete, temporarily unavailable, or listed on a drug shortage list. (4) For every drug for which the pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the pharmacy benefit manager shall make available to all pharmacies both of the following: (a) Information identifying the national drug pricing compendia or sources used to obtain the drug price data. (b) The comprehensive list of drugs subject to maximum allowable cost by plan and the actual maximum allowable cost by plan for each drug. B. A pharmacy benefit manager shall do all of the following: (1) Provide access to its Maximum Allowable Cost List to each pharmacy subject to the list. (2) Update its Maximum Allowable Cost List on a timely basis, but in no event longer than seven calendar days from a change in the methodology on which the Maximum Allowable Cost List is based or in the value of a variable involved in the methodology. (3) Provide a process for each pharmacy subject to the list to review an update to the Maximum Allowable Cost List.