02-031 C.M.R. ch. 210, § 3 - Definitions

The definitions applicable to this rule are contained in 24-A M.R.S. §4347. In addition to those definitions, the following definitions apply:

1. Pharmaceutical rebate. "Pharmaceutical rebate" means a discount or other price concession that is paid by a manufacturer or third party directly or indirectly to a PBM or a pharmacy, other than a discount or price concession that is fully disclosed and reflected at the point of sale by incorporation into the ingredient cost paid by the carrier and the calculation of the enrollee's cost sharing amount.

2. Spread pricing. "Spread pricing" means the model of prescription drug pricing in which the PBM charges a carrier or other health benefit payer a contracted price for prescription drugs that may differ from the price the PBM pays a pharmacy for the drugs.

Notes

02-031 C.M.R. ch. 210, § 3