LAC 37:XIII.18509. Roles and Responsibilities of Pharmacy Services Administrative Organizations

A. The roles and responsibilities solely within the purview of pharmacy services administrative organizations are as follows: 1. negotiating contracts, drug reimbursement rates, payments, and audit terms on behalf of pharmacy clients with pharmacy benefit managers; 2. billing and collecting payments from payers on behalf of pharmacies; 3. using contractual agreements to develop networks of member pharmacies. These agreements generally authorize pharmacy services administrative organizations to interact with third-party payers and pharmacy benefit managers; 4. negotiating access for pharmacies to networks and patients; 5. facilitating the purchase of prescription drugs and other medical products from drug manufacturers and providing for delivery to pharmacies for dispensing; and 6. assisting pharmacy clients with business strategy, pricing appeals, claims reconciliation, and certification and credentialing requirements.