§ 27-1-24.5-19.5 — Federal drug pricing program

Indiana § 27-1-24.5-19.5

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

Text

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 service basis.
(b) As used in this section, "340B covered entity" means an entity
authorized to participate in the federal 340B Drug Pricing Program
under Section 340B(a)(4) of the federal Public Health Service Act (42
U.S.C. 256b(a)(4)) and includes any pharmacy under contract with the
entity to dispense drugs on behalf of the entity.
(c) The following provisions may not be contained in a contract
between a pharmacy benefit manager and a 340B covered entity:
(1) A reimbursement rate for a prescription drug that would
diminish the 340B benefit to a 340B covered entity.
(2) A fee or adjustment that is not imposed on a pharmacy that is
not a 340B covered entity.
(3) A fee or adjustment amount that exceeds the fee or adjustment
amount imposed on a pharmacy that is not a 340B covered entity.
(4) Any provision that prevents or interferes with an individual's
choice to receive a prescription drug from a 340B covered entity,
including the administration of the drug.
(5) Any provision that excludes a 340B covered entity from
pharmacy benefit manager networks based on the 340B covered
entity's participation in the federal 340B Drug Pricing Program.
(6) Any provision that discriminates against a 340B covered
entity.
A violation of this subsection by a pharmacy benefit manager
constitutes an unfair or deceptive act or practice in the business of
insurance under IC 27-4-1-4.
(d) For contracts between a pharmacy benefit manager and a 340B
covered entity that are entered into, amended, or renewed after June 30,
2021, a provision that violates subsection (c) is considered void and
unenforceable.

Legislative History

As added by P.L.196-2021, SEC.23. Amended by P.L.213-2025, SEC.298.