§ 5-10-8-20 — Right to provide prescription cost information; point of sale cost limit; pharmacist may not be required to collect higher copayment

Indiana § 5-10-8-20

• Jurisdiction: Indiana
• Title 5: STATE AND LOCAL ADMINISTRATION
• Art. 10: PUBLIC EMPLOYEE BENEFITS
• Ch. 8: Group Insurance for Public Employees

Text

(a) As used in this section, "covered
individual" means an individual entitled to coverage under a state
employee plan.
(b) As used in this section, "drug" means a prescription drug.
(c) As used in this section, "pharmacy" refers to a pharmacist or
pharmacy that has entered into an agreement with a state employee
plan to provide drugs to individuals covered under a state employee
plan.
(d) As used in this section, "state employee plan" refers to the
following that provide coverage for drugs:
(1) A self-insurance program established under section 7(b) of
this chapter to provide group health coverage.
(2) A contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter.
The term includes a person that administers drug benefits on behalf of
a state employee plan.
(e) A pharmacy or pharmacist shall have the right to provide a
covered individual with information concerning the amount of the
covered individual's cost share for a prescription drug. Neither a
pharmacy nor a pharmacist shall be proscribed by a pharmacy benefit
manager from discussing this information or from selling to the
covered individual a more affordable alternative if an affordable
alternative is available.
(f) A pharmacy benefit manager that covers prescription drugs may
not include a provision that requires a covered individual 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 pharmacy benefit
manager at the point of sale.
This subsection does not prohibit the adjudication of claims in
accordance with the state employee plan administered by a pharmacy
benefit manager. The covered individual is not liable for any additional
charges or entitled to any credits as a result of the adjudicated claim.
(g) The state employee plan or a pharmacy benefit manager may not
require a pharmacy or pharmacist to collect a higher copayment for a
prescription drug from a covered individual than the state employee
plan or pharmacy benefit manager allows the pharmacy or pharmacist
to retain.

Legislative History

As added by P.L.209-2018, SEC.1. Amended by P.L.114-2020, SEC.1; P.L.9-2022, SEC.6.