A PBM may not impose a copayment or coinsurance requirement for a covered drug that exceeds the lesser of the applicable cost-sharing amount or the amount an individual would pay for the drug if the individual were paying the usual and customary price.

Link to Existing Law: DE ST TI 18 § 3350B

PRACTICAL NOTE

While this law does not apply directly to DIR fees, it would prevent post-point-of-sale clawbacks when the patient’s copayment amount is greater than the amount the pharmacy stands to retain.