Indiana Code 12-15-13.6-1. Audit of Medicaid prescription drug cost sharing; request for proposal
(1) the state board of accounts; or
Terms Used In Indiana Code 12-15-13.6-1
- Attorney: includes a counselor or other person authorized to appear and represent a party in an action or special proceeding. See Indiana Code 1-1-4-5
- Fraud: Intentional deception resulting in injury to another.
shall conduct an audit examining prescription drug cost sharing for the Medicaid program.
(b) The attorney general may, for an audit described under IC 27-1-3.7, issue a request for proposal under IC 27-1-3.7 to evaluate and determine whether to include the following in the request for proposal for the audit:
(1) 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 within 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 for inclusion in the audit of the Medicaid program.
This subsection expires December 31, 2025.
As added by P.L.196-2021, SEC.3. Amended by P.L.233-2023, SEC.1.