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Participation of independent community pharmacies - R.I. Gen. Laws Ann. § 27-29.1-5

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Pharmacies that do not participate in an insurer’s restricted pharmacy network contract (“independent community pharmacies”) may fill prescriptions for insured individuals and receive payment from the insurer as if they were operating pursuant to a network contract so long as they agree to various conditions. The conditions include (1) participating “in the insurer’s utilization review and quality assurance programs; (2) providing “computerized online eligibility determinations and claims submissions as required of pharmacies in the insurer’s restricted pharmacy network; and (3) protecting “the insurer’s proprietary information and an insured’s confidentiality and privacy.” An insurer may waive any of the listed conditions, but may not impose conditions on independent community pharmacies that are more restrictive than those required by in-network pharmacies.

Current as of June 2015