Indiana § 27-1-24.2-16 Prohibited actions

Indiana Statutes

§ 27-1-24.2-16 — Prohibited actions

Indiana § 27-1-24.2-16

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 24.2Pharmacy Benefits

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Bluebook

Ind. Code § 27-1-24.2-16 (2026).

Text

Effective 1-1-2026. 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 pharmacist from, or impose a penalty on a pharmacy or pharmacist for:

(A)selling a lower cost alternative to an insured, if a lower cost alternative is available; or

(B)providing information to an insured under subsection (c);

(2)discriminate against any pharmacy or pharmacist that is:

(A)located within the geographic coverage area of the health plan; and

(B)willing to agree to, or accept, terms and conditions established for participation in the insurer's, pharmacy benefit manager's, other admini

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Effective 1-1-2026.
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 pharmacist from, or impose a penalty
on a pharmacy or pharmacist for:
(A) selling a lower cost alternative to an insured, if a lower cost
alternative is available; or
(B) providing information to an insured under subsection (c);
(2) discriminate against any pharmacy or pharmacist that is:
(A) located within the geographic coverage area of the health
plan; and
(B) willing to agree to, or accept, terms and conditions
established for participation in the insurer's, pharmacy benefit
manager's, other administrator's, or health plan's network;
(3) impose limits, including quantity limits or refill frequency
limits, on an insured's access to medication from a pharmacy that
are more restrictive than those existing for a pharmacy affiliate;
(4) except as provided in subsection (b), require an insured to
receive pharmacy or pharmacist services from a pharmacy
affiliate, including:
(A) requiring an insured to obtain a specialty drug from a
pharmacy affiliate; and
(B) charging less cost sharing to insureds that use pharmacy
affiliates than what is charged to insureds that use nonaffiliated
pharmacies;
(5) require a pharmacy or pharmacist to enter into an additional
contract with an affiliate of the insurer, pharmacy benefit
manager, or other administrator of pharmacy benefits as a
condition of entering into a contract with this insurer, pharmacy
benefit manager, or administrator; or
(6) require a pharmacy or pharmacist to, as a condition of a
contract, agree to payment rates for any affiliate of the insurer,
pharmacy benefit manager, or other administrator of pharmacy
benefits that is not a party to the contract.
(b) Subsection (a)(4):
(1) does not apply to a mail order pharmacy; and
(2) may not be construed to prohibit:
(A) communications to insureds regarding networks and prices
if the communication is accurate and includes information
about all eligible nonaffiliated pharmacies; or
(B) an insurer, a pharmacy benefit manager, or any other
administrator of pharmacy benefits from providing financial
incentives for utilizing the network, if the insurer, pharmacy
benefit manager, or other administrator complies with this
section and section 14 of this chapter.
(c) A pharmacist shall have the right to provide an insured with
information regarding lower cost alternatives to assist the insured in
making informed decisions.