§ 27-8-11-12 — Right to provide prescription cost information; point of sale cost limit; pharmacist may not be required to collect higher copayment

Indiana § 27-8-11-12

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 11: Accident and Sickness Insurance─Reimbursement

Text

(a) As used in this section, "drug" means a
prescription drug.
(b) As used in this section, "insurer" refers to an insurer that
provides coverage for drugs. The term includes a person that
administers drug benefits on behalf of an insurer.
(c) As used in this section, "pharmacy" refers to a pharmacist or
pharmacy that has entered into an agreement with an insurer under
section 3 of this chapter.
(d) A pharmacy or pharmacist shall have the right to provide an
insured with information concerning the amount of the insured's cost
share for a prescription drug. Neither a pharmacy nor a pharmacist
shall be proscribed by an insurer from discussing this information or
from selling to the insured a more affordable alternative if an
affordable alternative is available.
(e) An insurer that covers prescription drugs may not include a
provision that requires an insured 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 insurer at the
point of sale.
This subsection does not prohibit the adjudication of claims in
accordance with an accident and sickness insurance policy issued or
administered by an insurer. The insured is not liable for any additional
charges or entitled to any credits as a result of the adjudicated claim.
(f) The insurer or a pharmacy benefit manager may not require a
pharmacy or pharmacist to collect a higher copayment for a
prescription drug from an insured than the insurer or pharmacy benefit
manager allows the pharmacy or pharmacist to retain.

Legislative History

As added by P.L.209-2018, SEC.12. Amended by P.L.114-2020, SEC.20; P.L.9-2022, SEC.52.