§ 27-1-24.5-12 — "Pharmacy benefit manager"

Indiana § 27-1-24.5-12

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 1: DEPARTMENT OF INSURANCE
• Ch. 24.5: Pharmacy Benefit Managers

Text

Note: This version of section effective until 1-1-2026. See also
following version of this section, effective 1-1-2026.
Sec. 12. (a) As used in this chapter, "pharmacy
benefit manager" means an entity that, on behalf of a health plan, state
agency, insurer, managed care organization, or other third party payor:
(1) contracts directly or indirectly with pharmacies to provide
prescription drugs to individuals;
(2) administers a prescription drug benefit;
(3) processes or pays pharmacy claims;
(4) creates or updates prescription drug formularies;
(5) makes or assists in making prior authorization determinations
on prescription drugs;
(6) administers rebates on prescription drugs; or
(7) establishes a pharmacy network.
(b) The term does not include the following:
(1) A person licensed under IC 16.
(2) A health provider who is:
(A) described in IC 25-0.5-1; and
(B) licensed or registered under IC 25.
(3) A consultant who only provides advice concerning the
selection or performance of a pharmacy benefit manager.

Legislative History

As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.77.