Indiana § 27-1-3.7-3 State employee health plan audit and Medicaid audit; request for
proposal; contract requirements

Indiana Statutes

§ 27-1-3.7-3 — State employee health plan audit and Medicaid audit; request for proposal; contract requirements

Indiana § 27-1-3.7-3

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 3.7Audit of Pharmacy Benefit Managers Contracted with

This text of Indiana § 27-1-3.7-3 (State employee health plan audit and Medicaid audit; request for proposal; contract requirements) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-3.7-3 (2026).

Text

(a)Before September 1, 2023, the attorney general may issue a request for proposal for a state employee health plan audit and a Medicaid audit. The attorney general may evaluate and determine whether to include the following in the request for proposal in the audit of prescription drugs:

(1)Prescription drug 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)

Free access — add to your briefcase to read the full text and ask questions with AI

(a) Before September 1, 2023, the attorney
general may issue a request for proposal for a state employee health
plan audit and a Medicaid audit. The attorney general may evaluate and
determine whether to include the following in the request for proposal
in the audit of prescription drugs:
(1) Prescription drug 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 by the state
employee health plan or 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.
(b) The attorney general may consult with the state personnel
department and the office of the secretary of family and social services
in:
(1) developing the request for proposal; and
(2) awarding the contract.
(c) If the attorney general decides to issue a request for proposal
under this chapter, the attorney general shall develop the request for
proposal in a manner that would begin the audit before February 1,
2024.
(d) Any contract between the state personnel department or the
office of the secretary of family and social services for the
administration of prescription drugs must include a provision to require
the person to cooperate with an audit conducted under this chapter and
provide the required information to the person awarded the contract for
the audit.