Prohibited practices [For application of this section, see 83 Del. Laws, c. 256, § 15].
Del. Code tit. 18, § 3372A
in effectA pharmacy benefits manager or representative of a pharmacy benefits manager may not do any of the following:
(1) Engage in spread pricing.
(2) Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.
(3) Unless reviewed and approved by the Commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including a fee for any of the following:
a. The receipt and processing of a pharmacy claim.
b. The development or management of claims processing services in a pharmacy benefits manager network.
c. Participation in a pharmacy benefits manager network.
(4) Unless reviewed and approved by the Commissioner in coordination with the Board of Pharmacy, require pharmacy accreditation standards or certification requirements inconsistent with, more stringent than, or in addition to requirements of the Board of Pharmacy.
(5) Violate § 3325A(b) of this title.
(6) Violate § 3362A of this title.
(7) Pay or reimburse a pharmacy or pharmacist for the ingredient drug product component of pharmacist services less than the national average drug acquisition cost that was in effect on the date of service. If the national average drug acquisition cost is unavailable, the wholesale acquisition cost should be applied. The wholesale acquisition cost price must be the price published in effect on the date of service for the drug claim.
(8) Make or permit any reduction of payment for pharmacy goods or services by a pharmacy benefits manager or an insurer directly or indirectly to a pharmacy under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payment.
(9) After adjudication of a claim for pharmacy goods or services, directly or indirectly retroactively deny or reduce the claim unless 1 or more of the following applies:
a. The original claim was intentionally submitted fraudulently.
b. The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacy goods or services.
c. The pharmacy goods or services were not properly rendered by the pharmacy or pharmacist.
(10) Amend a contract between a pharmacy benefits manager and a pharmacy or pharmacist without providing at least 60 days’ notice to the affected pharmacy or pharmacist.
(11) Require pharmacists to break open unit-of-use items beyond manufacturer recommendations if the only commercially available package size exceeds the minimum days’ supply. Packaging labeled “for single-patient-use only” shall be deemed to be the smallest package size available.
(12) Require a pharmacy to dispense a therapeutically equivalent or therapeutically alternative drug that costs the enrollee more out-of-pocket than the prescribed drug, unless the substitution is made for medical reasons that benefit the enrollee.
(13) Transfer or share prescription information containing enrollee-identifiable or prescriber-identifiable data to an affiliated pharmacy for any commercial purpose other than the purposes of facilitating pharmacy reimbursement, formulary compliance, or utilization review.
Source: DE Code (Official Site)URL: https://delcode.delaware.gov/title18/c033a/sc07/index.htmlFetched: 10/4/2026