insurance risk

(7) Insurance risk The term “insurance risk” means, with respect to a participating pharmacy, risk of the type commonly assumed only by insurers licensed by a State and does not include payment variations designed to reflect performance-based measures of activities within the control of the pharmacy, such as formulary compliance and generic drug substitution.


42 USC § 1395w-151(a)(7)

Scoping language

For purposes of this part
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