{"data":{"id":"us-ky/krs-304.17a-597","jurisdiction":"us-ky","citation":"KRS 304.17A-597","heading":"Prohibition against certain actions of administrator of pharmacy","body":"benefits against pharmacy -- Right of pharmacist to provide information about\nlower cost alternatives to insured.\nTo the extent permitted under federal law and except as provided in KRS 304.17A-595:\n(1) With respect to the provision of pharmacy or pharmacist services under a health\nplan, an insurer, a pharmacy benefit manager, or any other administrator of\npharmacy benefits:\n(a) Shall not:\n1. a. Require or incentivize a n insured to use a mail -order\npharmaceutical distributor, including a mail-order pharmacy.\nb. Conduct prohibited under this subparagraph includes but is not\nlimited to imposing any cost-sharing requirement, fee, drug supply\nlimitation, or other condition r elating to pharmacy or pharmacist\nservices received from a retail pharmacy that is greater, or more\nrestrictive, than what would otherwise be imposed if the insured\nused a mail -order pharmaceutical distributor, including a mail -\norder pharmacy;\n2. Prohibit a pharmacy or pharmacist from, or impose a penalty on a\npharmacy or pharmacist for, the following:\na. Selling a lower cost alternative to an insured, if one is available; or\nb. Providing information to an insured un der subsection (2) of this\nsection;\n3. Discriminate against any pharmacy or pharmacist that is:\na. Located within the geographic coverage area of the health plan;\nand\nb. Willing to agree to, or accept, reasonable terms and conditions\nestablished for partic ipation in the insurer's, pharmacy benefit\nmanager's, other administrator's, or health plan's network;\n4. Impose limits, including quantity limits or refill frequency limits, on an\ninsured's access to medication from a pharmacy that are more restrictive\nthan those existing for a pharmacy affiliate;\n5. a. Require or incentivize an insured to receive pharmacy or\npharmacist services from a pharmacy affiliate.\nb. Conduct prohibited under this subparagraph includes but is not\nlimited to:\ni. Requiring or incentiv izing an insured to obtain a specialty\ndrug from a pharmacy affiliate;\nii. Charging less cost sharing to insureds that use pharmacy\naffiliates than what is charged to insureds that use\nnonaffiliated pharmacies; and\niii. Providing any incentives for insured s that use pharmacy\naffiliates that are not provided for insureds that use\nnonaffiliated pharmacies.\nc. This subparagraph shall not be construed to prohibit:\ni. Communications to insureds regarding networks and prices\nif the communication is accurate and i ncludes information\nabout all eligible nonaffiliated pharmacies; or\nii. Requiring an insured to utilize a network that may include\npharmacy affiliates in order to receive coverage under the\nplan, or providing financial incentives for utilizing that\nnetwork, if the insurer, pharmacy benefit manager, or other\nadministrator complies with this section and KRS 304.17A -\n593; or\n6. a. Interfere with an insured's right to choose the insured's network\npharmacy of choice.\nb. For purposes of this subparagraph, interfer ing includes inducing,\nsteering, offering financial or other incentives, and imposing a\npenalty, including but not limited to:\ni. Promoting one (1) participating pharmacy over another;\nii. Offering a monetary advantage;\niii. Charging higher cost sharing; and\niv. Reducing an insured's allowable reimbursement for\npharmacy or pharmacist services; and\n(b) Shall:\n1. Provide equal access and incentives to all pharmacies within the\ninsurer's, pharmacy benefit manager's, other administrator's, or health\nplan's network; and\n2. Offer all pharmacies located in the health plan's geographic coverage\narea eligibility to participate in the insurer's, pharmacy benefit\nmanager's, other administrator's, or health plan's network under identical\nreimbursement terms for the prov ision of pharmacy or pharmacist\nservices; and\n(2) A pharmacist shall have the right to provide an insured information regarding lower\ncost alternatives to assist the insured in making informed decisions.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55759","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"7e5f3903005b7898df2683437f6d947e1d768052580302dbad913b17b77320da","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-595","next":"us-ky/krs-304.17a-599"},"notice":"GroundRules: Original legal text. Not legal advice."}