Title 27, INSURANCE

Sec. 12. As used in this chapter, "pharmacy benefit manager" has the meaning set forth in IC 27-1-24.5-12. As added by P.L.189-2025, SEC.1.

Sec. 13. (a) As used in this chapter, "pharmacy or pharmacist services" means any: (1) health care procedures or treatments within the scope of practice of a pharmacist; or (2) services provided by a pharmacy or pharmacist. (b) The term includes the sale and provision of the foll…

Sec. 14. (a) An insurer, a pharmacy benefit manager, or any other administrator of pharmacy benefits that utilizes a network to provide pharmacy or pharmacist services under a health plan shall ensure that the network is reasonably adequate and accessible with respect to the prov…

Sec. 15. (a) A contract between a pharmacy or pharmacist and an insurer, a pharmacy benefit manager, or any other administrator of pharmacy benefits for the provision of pharmacy or pharmacist services under a health plan, either directly or through a pharmacy services administra…

Sec. 16. (a) Except as provided in section 15 of this chapter, with respect to the provision of pharmacy or pharmacist services under a health plan, an insurer, a pharmacy benefit manager, or any other administrator of pharmacy benefits may not: (1) prohibit a pharmacy or pharmac…

Sec. 17. (a) Any insured, pharmacy, or pharmacist impacted by an alleged violation of this chapter may file a complaint with the commissioner. (b) The commissioner shall: (1) review and investigate all complaints filed under this section; and (2) issue, in writing, a determinatio…

Sec. 18. (a) This section applies to a state employee health plan (as defined in IC 5-10-8-6.7). If a pharmacy benefit manager is used with regard to a state employee health plan, the state personnel department shall either: (1) create a pharmacy benefit manager within the state …

Sec. 19. (a) As used in this section, "plan sponsor" means an employer or organization that: (1) has more than one hundred (100) employees or members; and (2) offers health insurance coverage to its employees or members through a self-funded health benefit plan. (b) A third party…

Sec. 2. As used in this chapter, "actual overpayment" means the portion of any amount paid for pharmacy or pharmacist services that: (1) is duplicative because the pharmacy or pharmacist has already been paid for the services; or (2) was erroneously paid because the services were…

Sec. 20. In addition to any other remedies, penalties, or damages available under common law or statute, the commissioner may order reimbursement to any person who has incurred a monetary loss as a result of a violation of this chapter. As added by P.L.189-2025, SEC.1.

Sec. 21. This chapter applies to the extent that it is not in conflict with federal law. As added by P.L.189-2025, SEC.1.

Sec. 3. As used in this chapter, "common control" includes: (1) sharing common management or managers; and (2) having common members on boards of directors. As added by P.L.189-2025, SEC.1.

Sec. 4. As used in this chapter, "cost sharing" means the cost to an insured under a health plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the health plan. As added by P.L.189-2025, SEC.1.

Sec. 5. (a) As used in this chapter, "health plan" means the following: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a). (2) An individual contract (as defined in IC 27-13-…

Sec. 6. As used in this chapter, "insured" means an individual covered under a health plan. As added by P.L.189-2025, SEC.1.

Sec. 7. As used in this chapter, "insurer" means any of the following that offer or issue a health plan: (1) An insurance company. (2) A health maintenance organization. (3) A limited health service organization. (4) A self-insurer, including a governmental plan, church plan, or …

Sec. 8. As used in this chapter, "national drug code number" means the unique national drug code number that identifies: (1) a specific approved drug; (2) the manufacturer of the drug; and (3) the package presentation of the drug. As added by P.L.189-2025, SEC.1.

Sec. 9. As used in this chapter, "net amount" means the amount paid to a pharmacy or pharmacist by the insurer, pharmacy benefit manager, or other administrator minus: (1) any fees; (2) any price concessions; and (3) all other revenue; passing from the pharmacy or pharmacist to t…

Sec. 0.1. The addition of this chapter by P.L.109-2008 applies to a policy of accident and sickness insurance that is issued, delivered, amended, or renewed after June 30, 2008. As added by P.L.220-2011, SEC.450.

Sec. 1. As used in this chapter, "insured" means an individual who is entitled to coverage under a policy of accident and sickness insurance. As added by P.L.109-2008, SEC.2.

Sec. 10. For purposes of this section, "items and services" does not include preventive services for which coverage is provided under a high deductible health plan (as defined in 26 U.S.C. 220(c)(2) or 26 U.S.C. 223(c)(2)). The coverage required under section 5 of this chapter ma…

Sec. 2. As used in this chapter, "orthotic device" means a medically necessary custom fabricated brace or support that is designed as a component of a prosthetic device. As added by P.L.109-2008, SEC.2.

Sec. 3. (a) As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1. (b) The term does not include the following: (1) Accident only, credit, dental, vision, Medicare, Medicare supplement, long term care, or disability income i…

Sec. 4. As used in this chapter, "prosthetic device" means an artificial leg or arm. As added by P.L.109-2008, SEC.2.

Sec. 5. A policy of accident and sickness insurance must provide coverage for orthotic devices and prosthetic devices, including repairs or replacements, that: (1) are provided or performed by a person that is: (A) accredited as required under 42 U.S.C. 1395m(a)(20); or (B) a qua…

Sec. 6. The: (1) coverage required under section 5 of this chapter must be equal to the coverage that is provided for the same device, repair, or replacement under the federal Medicare program (42 U.S.C. 1395 et seq.); and (2) reimbursement under the coverage required under secti…

Sec. 7. Except as provided in sections 8 and 9 of this chapter, the coverage required under section 5 of this chapter: (1) may be subject to; and (2) may not be more restrictive than; the provisions that apply to other benefits under the policy of accident and sickness insurance.…

Sec. 8. The coverage required under section 5 of this chapter may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit. As added by P.L.109-2008, SEC.2.

Sec. 9. Any lifetime maximum coverage limitation that applies to prosthetic devices and orthotic devices: (1) must not be included in; and (2) must be equal to; the lifetime maximum coverage limitation that applies to all other items and services generally under the policy of acc…