Fee or performance-based reimbursement related to claim adjudication.

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    A pharmacy benefits manager or a purchaser may not directly or indirectly charge a contracted pharmacy, or hold a contracted pharmacy responsible for, a fee or performance–based reimbursement related to the adjudication of a claim or an incentive program that is not:

        (1)    specifically enumerated by the pharmacy benefits manager or purchaser at the time of claim processing; or

        (2)    reported on the initial remittance advice of an adjudicated claim.


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