Sec. 19.5. (a) This section:

(1) applies to a Medicaid managed care organization (as defined in 42 U.S.C. § 1396b(m)); and

Terms Used In Indiana Code 27-1-24.5-19.5

  • Contract: A legal written agreement that becomes binding when signed.
  • Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. 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

(2) does not apply to the state Medicaid program when Medicaid provides reimbursement for covered outpatient drugs (as defined in 42 U.S.C. §§ 1396r-8(k)) on a fee for service basis.

     (b) As used in this section, “340B covered entity” means an entity authorized to participate in the federal 340B Drug Pricing Program under Section 340B(a)(4) of the federal Public Health Service Act (42 U.S.C. § 256b(a)(4)) and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity.

     (c) The following provisions may not be contained in a contract between a pharmacy benefit manager and a 340B covered entity:

(1) A reimbursement rate for a prescription drug that would diminish the 340B benefit to a 340B covered entity.

(2) A fee or adjustment that is not imposed on a pharmacy that is not a 340B covered entity.

(3) A fee or adjustment amount that exceeds the fee or adjustment amount imposed on a pharmacy that is not a 340B covered entity.

(4) Any provision that prevents or interferes with an individual’s choice to receive a prescription drug from a 340B covered entity, including the administration of the drug.

(5) Any provision that excludes a 340B covered entity from pharmacy benefit manager networks based on the 340B covered entity’s participation in the federal 340B Drug Pricing Program.

(6) Any provision that discriminates against a 340B covered entity.

A violation of this subsection by a pharmacy benefit manager constitutes an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.

     (d) For contracts between a pharmacy benefit manager and a 340B covered entity that are entered into, amended, or renewed after June 30, 2021, a provision that violates subsection (c) is considered void and unenforceable.

As added by P.L.196-2021, SEC.23.

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