Title 26, Chapter 4, Section 142
As used in this article, the term:
(1) "Administrator" means that person, corporation, or business
entity which administers a program, is legally liable for any
payments to a participating pharmacy under a program, or both.
(2) "Commissioner" means the Commissioner of Insurance.
(3) "Contract" means a program contract.
(4) "Enrollee" means a consumer who receives pharmaceuticals under
(5) "Participating pharmacy" means a pharmacy having a contract to
provide pharmaceuticals to enrollees under a program.
(6) "Pharmaceuticals" means drugs, devices, or services available
from a pharmacy.
(7) "Prevailing rate" means the average wholesale price of the
pharmaceutical during the applicable period, plus the usual,
customary, and reasonable dispensing fee added thereto, provided
that in no event shall the amount submitted for reimbursement by a
pharmacy under this article exceed the eighty-fifth percentile of
the retail prices charged by all pharmacies in Georgia for the
same or similar pharmaceuticals during such period of time or the
actual price charged by the submitting pharmacy to consumers,
other than enrollees, for the same or similar pharmaceuticals
during such period of time, whichever is less.
(8) "Program" means a third-party prescription program.
(9) "Program contract" means that contract creating rights and
obligations between a participating pharmacy and a program or
(10) "Program identification card" means a document which
identifies enrollees as participants in a program.
(11) "Third-party prescription program" means any system of
providing payments or reimbursement of payments made for
pharmaceuticals pursuant to a contract between a pharmacy and
another party, including insurance companies and administrators of
programs, who are not consumers of the pharmaceuticals under that
contract and shall include, without being limited to, insurance
plans whereby an enrollee receives pharmaceuticals which are paid
for by insurance companies or administrators, or by an agent of
his employer, or by others.