Indiana § 27-13-15-6 Right to provide prescription cost information; point of sale cost limit;
pharmacist may not be required to collect higher copayment

Indiana Statutes

§ 27-13-15-6 — Right to provide prescription cost information; point of sale cost limit; pharmacist may not be required to collect higher copayment

Indiana·Title 27 INSURANCE·Art. 13 HEALTH MAINTENANCE ORGANIZATIONS·Ch. 15 Participating Providers; Contracts and Legal Actions

(a)As used in this section, "drug" means a prescription drug.

(b)As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for drugs. The term includes the following:

(1)A limited service health maintenance organization.

(2)A person that administers drug benefits on behalf of a health maintenance organization or a limited service health maintenance organization.

(c)As used in this section, "pharmacy" refers to a pharmacist or pharmacy that is a participating provider.

(d)A pharmacy or pharmacist shall have the right to provide an enrollee with information concerning the amount of the enrollee's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a health maintenance organiza

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

(a) As used in this section, "drug" means a
prescription drug.
(b) As used in this section, "health maintenance organization" refers
to a health maintenance organization that provides coverage for drugs.
The term includes the following:
(1) A limited service health maintenance organization.
(2) A person that administers drug benefits on behalf of a health
maintenance organization or a limited service health maintenance
organization.
(c) As used in this section, "pharmacy" refers to a pharmacist or
pharmacy that is a participating provider.
(d) A pharmacy or pharmacist shall have the right to provide an
enrollee with information concerning the amount of the enrollee's cost
share for a prescription drug. Neither a pharmacy nor a pharmacist
shall be proscribed by a health maintenance organization from
discussing this information or from selling to the enrollee a more
affordable alternative if an affordable alternative is available.
(e) A health maintenance organization that covers prescription drugs
may not include a provision that requires an enrollee to make payment
for a prescription drug at the point of sale in an amount that exceeds the
lesser of:
(1) the contracted copayment amount; or
(2) the amount of total approved charges by the health
maintenance organization at the point of sale.
This subsection does not prohibit the adjudication of claims in
accordance with an individual contract or group contract issued or
administered by a health maintenance organization. The enrollee is not
liable for any additional charges or entitled to any credits as a result of
the adjudicated claim.
(f) The health maintenance organization or a pharmacy benefit
manager may not require a pharmacy or pharmacist to collect a higher
copayment for a prescription drug from an enrollee than the health
maintenance organization or pharmacy benefit manager allows the
pharmacy or pharmacist to retain.

Indiana § 27-13-15-6 (Right to provide prescription cost information; point of sale cost limit; pharmacist may not be required to collect higher copayment) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.