Indiana Code 27-1-24.5-22.6. Filing complaints with department of insurance
(b) If a contracted pharmacy or pharmacy services administrative organization believes that its contract with a pharmacy benefit manager contains an unlawful contractual provision regarding reimbursement rates, the contracted pharmacy or pharmacy services administrative organization may file a complaint with the department.
Terms Used In Indiana Code 27-1-24.5-22.6
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
- pharmacy: means the physical location:
Indiana Code 27-1-24.5-11
- pharmacy benefit manager: means an entity that, on behalf of a health plan, state agency, insurer, managed care organization, or other third party payor:
Indiana Code 27-1-24.5-12
- pharmacy services administrative organization: means an organization that assists independent pharmacies and pharmacy benefit managers or health plans to achieve administrative efficiencies, including contracting and payment efficiencies. See Indiana Code 27-1-24.5-15
(1) The specific actions taken by the pharmacy benefit manager with respect to:
(A) the appeal, for a complaint filed under subsection (a); or
(B) the contract, for a complaint filed under subsection (b).
(2) A good faith estimate of the time required for a resolution of the complaint.
(d) If a pharmacy believes that its contract with a pharmacy services administrative organization contains an unlawful contractual provision regarding reimbursement rates, the pharmacy may file a complaint with the department.
(e) The department shall establish a process for complaints filed under this section.
As added by P.L.196-2021, SEC.25.