Title 27, INSURANCE

Sec. 11. As used in this chapter, "pharmacy" means the physical location: (1) that is licensed under IC 25-26; and (2) at which drugs, chemicals, medicines, prescriptions, and poisons are compounded, dispensed, or sold at retail. As added by P.L.68-2020, SEC.1.

Sec. 11.5. As used in this chapter, "pharmacy benefit management services" means: (1) negotiating the price of prescription drugs, including negotiating and contracting for direct or indirect rebates, discounts, or other price concessions; (2) managing any aspect of a prescriptio…

Sec. 12. (a) As used in this chapter, "pharmacy benefit manager" means: (1) a person who, under a written agreement with an insurer, health plan, state agency, managed care organization, or other third party payor, directly or indirectly provides one (1) or more pharmacy benefit …

Sec. 13. As used in this chapter, "pharmacy benefit manager affiliate" means a pharmacy or pharmacist that directly or indirectly, through one (1) or more intermediaries: (1) owns or controls; (2) is owned or controlled by; or (3) is under common ownership or control with; a phar…

Sec. 14. As used in this chapter, "pharmacy benefit manager network" means a group of pharmacies or pharmacists that is offered: (1) through an agreement or health plan contract; and (2) to provide pharmacist services for health plans. As added by P.L.68-2020, SEC.1.

Sec. 15. As used in this chapter, "pharmacy services administrative organization" means an organization that assists independent pharmacies and pharmacy benefit managers or health plans to achieve administrative efficiencies, including contracting and payment efficiencies. As add…

Sec. 16. (a) As used in this chapter, "rebate" means a discount or other price concession that is: (1) based on use of a prescription drug; and (2) paid by a manufacturer or third party to a pharmacy benefit manager, pharmacy services administrative organization, or pharmacy afte…

Sec. 17. As used in this chapter, "third party" means a person other than a: (1) pharmacy benefit manager; or (2) covered individual. As added by P.L.68-2020, SEC.1.

Sec. 18. A person shall, before establishing or operating as a pharmacy benefit manager, apply to and obtain a license from the commissioner under this chapter. As added by P.L.68-2020, SEC.1.

Sec. 19. (a) A pharmacy benefit manager shall provide equal access and incentives to all pharmacies within the pharmacy benefit manager's network. (b) A pharmacy benefit manager may not do any of the following: (1) Condition participation in any network on accreditation, credenti…

Sec. 19.5. (a) This section does not apply to: (1) a Medicaid managed care organization (as defined in 42 U.S.C. 1396b(m)); and (2) the state Medicaid program when Medicaid provides reimbursement for covered outpatient drugs (as defined in 42 U.S.C. 1396r-8(k)) on a fee for servi…

Sec. 2. As used in this chapter, "effective rate of reimbursement" includes the following: (1) Generic effective rates. (2) Brand effective rates. (3) Direct and indirect remuneration fees. (4) Any other reduction or aggregate reduction of payment. As added by P.L.68-2020, SEC.1.…

Sec. 20. (a) The commissioner shall do the following: (1) Prescribe an application for use in applying for a license to operate as a pharmacy benefit manager. (2) Adopt rules under IC 4-22-2 to establish the following: (A) Pharmacy benefit manager licensing requirements. (B) Lice…

Sec. 21. (a) Beginning June 1, 2021, and annually thereafter, a pharmacy benefit manager shall submit a report containing data from the immediately preceding calendar year to the commissioner. The commissioner shall determine what must be included in the report and consider the f…

Sec. 22. (a) A pharmacy benefit manager shall do the following: (1) Identify to contracted: (A) pharmacy services administrative organizations; or (B) pharmacies if the pharmacy benefit manager contracts directly with pharmacies; the sources used by the pharmacy benefit manager t…

Sec. 22.5. Aggregated information compiled from reports submitted by pharmacy benefit managers to the insurance commissioner under section 22 of this chapter is not confidential except for information that would reveal a specific pharmacy benefit manager's proprietary information…

Sec. 22.6. (a) If a pharmacy benefit manager denies an appeal under section 22(a)(2) of this chapter, the appealing contracted pharmacy, pharmacy services administrative organization, or group purchasing organization may file a complaint with the department not later than thirty …

Sec. 23. (a) For every drug for which the pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the pharmacy benefit manager shall make available to a contracted pharmacy services administrative organization to make available t…

Sec. 24. (a) For every drug for which a pharmacy benefit manager establishes a maximum allowable cost to determine reimbursement for the drug product, the pharmacy benefit manager shall make available to the department, upon request of the department, information that is needed t…

Sec. 25. (a) A contract holder may, one (1) time in a calendar year and not earlier than six (6) months following a previously requested audit, request an audit of compliance with the contract. If requested by the contract holder, the audit shall include full disclosure of the fo…

Sec. 26. A person or entity that has contracted with a pharmacy benefit manager for the performance of services described in section 12(a) of this chapter is entitled to full disclosure from the pharmacy benefit manager of the terms of a contract between the pharmacy benefit mana…

Sec. 27. A pharmacy services administrative organization shall, upon request, fully disclose to an independent pharmacy on whose behalf the pharmacy services administrative organization acts the terms of a contract between the pharmacy services administrative organization and any…

Sec. 27.5. A pharmacy benefit manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from a customer than the pharmacy benefit manager allows the pharmacy or pharmacist to retain. As added by P.L.114-2020, SEC.16. Amended by P.L.32-…

Sec. 27.7. (a) This section applies to a health plan that is issued, delivered, amended, or renewed after December 31, 2025. (b) A pharmacy benefit manager shall apply the annual limitation on cost sharing set forth in the federal Patient Protection and Affordable Care Act under …

Sec. 28. (a) A violation of this chapter is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4. (b) The department may also adopt rules under IC 4-22-2 to set forth fines for a violation under this chapter. As added by P.L.68-2020, SEC.1.

Sec. 29. (a) At least every six (6) months, a pharmacy benefit manager shall provide a report to the department. (b) A report under subsection (a) must include the: (1) overall aggregate amount charged to a health plan for all pharmaceutical claims processed by the pharmacy benef…

Sec. 3. As used in this chapter, "equal access and incentives" means that a pharmacy benefit manager allows any willing pharmacy provider to participate as part of any of the pharmacy benefit manager's networks as long as the pharmacy provider agrees to the terms and conditions o…

Sec. 4. As used in this chapter, "generic drug" means a drug product that is identified by the drug's chemical name and that is: (1) accepted by the federal Food and Drug Administration; (2) available from at least three (3) sources; and (3) therapeutically equivalent to an origi…

Sec. 4.5. As used in this chapter, "health care service" means a service or good furnished for the purpose of preventing, alleviating, curing, or healing: (1) human illness; (2) physical disability; or (3) injury. As added by P.L.237-2025, SEC.2.

Sec. 5. As used in this chapter, "health plan" means a plan through which coverage is provided for health care services through insurance, prepayment, reimbursement, or otherwise. The term includes the following: (1) A state employee health plan (as defined in IC 5-10-8-6.7). (2)…

Sec. 6. As used in this chapter, "independent pharmacies" means pharmacies that are not a pharmacy benefit manager affiliate. As added by P.L.68-2020, SEC.1.

Sec. 6.5. As used in this chapter, "insurer" means an insurer subject to state law and rules regulating insurance or subject to the jurisdiction of the department that contracts, or offers to contract, to: (1) provide; (2) deliver; (3) arrange for; (4) pay for; or (5) reimburse; …

Sec. 7. As used in this chapter, "maximum allowable cost" means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a generic drug. The term does not include a dispensing fee or professional fee. As added by P.L.68-2020, SEC.1. Amended by …

Sec. 8. As used in this chapter, "maximum allowable cost list" means a list of drugs that is used: (1) by a pharmacy benefit manager; and (2) to set the maximum amount that may be reimbursed to a pharmacy or pharmacist for a drug. As added by P.L.68-2020, SEC.1.

Sec. 9. As used in this chapter, "pharmacist" means an individual licensed as a pharmacist under IC 25-26. As added by P.L.68-2020, SEC.1.