§ 12-15-13.6-1 — Audit of Medicaid prescription drug cost sharing; request for proposal

Indiana § 12-15-13.6-1

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 13.6: Audit of Prescription Drug Cost Sharing

Text

(a) Once every three (3) state fiscal years:
(1) the state board of accounts; or
(2) an independent auditor with experience auditing expenses
related to prescription drugs that is hired by the state board of
accounts;
shall conduct an audit examining prescription drug cost sharing for the
Medicaid program.
(b) The attorney general may, for an audit described under IC 27-1-3.7, issue a request for proposal under IC 27-1-3.7 to evaluate and
determine whether to include the following in the request for proposal
for the audit:
(1) Cost sharing.
(2) Spread pricing.
(3) Patient steering.
(4) Proper brand and generic definitions.
(5) Effective rate clawbacks.
(6) Medical loss ratio inflation.
(7) Formulary compliance.
(8) Discriminatory pricing.
(9) Specialty drug definition and categorization.
(10) Adherence to contracted pricing terms.
(11) Adherence to plan design, including:
(A) quantity limits; and
(B) prior authorization guidelines.
(12) Under market reimbursements to pharmacies.
(13) Dispensing fees.
(14) Lesser of logic pricing.
(15) Fraud, waste, and abuse.
(16) Rebates.
(17) Compliance with federal law.
(18) Review of practices of any of the following used within the
Medicaid program:
(A) Managed care organizations.
(B) Pharmacies.
(C) Pharmacy services administrative organizations.
(D) Wholesalers.
(E) Drug manufacturers.
(19) Any other metric determined by the attorney general for
inclusion in the audit of the Medicaid program.
This subsection expires December 31, 2025.

Legislative History

As added by P.L.196-2021, SEC.3. Amended by P.L.233-2023, SEC.1.