58-29E-13. Certain claims adjustments prohibited.
No pharmacy benefit manager contracting with a covered entity shall retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug unless the adjustment is a result of either of the following:
(1)A pharmacy audit conducted in accordance with chapter 58-29F; or
(2)A technical billing error.
Source: SL 2019, ch 213, ยง2.
Structure South Dakota Codified Laws
Chapter 29E - Pharmacy Benefits Management
Section 58-29E-1 - Definition of terms.
Section 58-29E-2 - Pharmacy benefits manager licensed as third party administrator.
Section 58-29E-3 - Manager to perform duties in good faith.
Section 58-29E-5 - Permission of entity required to contact covered individual--Exception.
Section 58-29E-6 - Confidentiality of information--Injunction--Damages.
Section 58-29E-7 - Audits of manager's books and records .
Section 58-29E-8 - Dispensation of substitute prescription drug for prescribed drug.
Section 58-29E-8.1 - Cost-sharing information not to be restricted.
Section 58-29E-9 - Rules--Content.
Section 58-29E-10 - Civil action--Enforcement of chapter--Damages.
Section 58-29E-11 - Application of chapter to certain contracts.
Section 58-29E-13 - Certain claims adjustments prohibited.
Section 58-29E-14 - Adjustment of claim due to error in adjudication permitted.