Indiana Code 27-1-24.5-25. Party’s right to audit; amounts paid; consideration
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Sec. 25. (a) A party that has contracted with a pharmacy benefit manager to provide services may, at least one (1) time in a calendar year, request an audit of compliance with the contract. The audit may include full disclosure of rebate amounts secured on prescription drugs, whether product specific or general rebates, that were provided by a pharmaceutical manufacturer and any other revenue and fees derived by the pharmacy benefit manager from the contract. A contract may not contain provisions that impose unreasonable fees or conditions that would severely restrict a party’s right to conduct an audit under this subsection.
(c) A pharmacy benefit manager shall provide notice to a party contracting with the pharmacy benefit manager of any consideration that the pharmacy benefit manager receives from a pharmacy manufacturer for any name brand dispensing of a prescription when a generic or biologically similar product is available for the prescription.
(b) A pharmacy benefit manager shall disclose, upon request from a party that has contracted with a pharmacy benefit manager, to the party the actual amounts paid by the pharmacy benefit manager to any pharmacy.
Terms Used In Indiana Code 27-1-24.5-25
- Commissioner: means the "insurance commissioner" of this state. See Indiana Code 27-1-2-3
- 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
- rebate: means a discount or other price concession that is:
Indiana Code 27-1-24.5-16
- Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5
(d) The commissioner may establish a procedure to release information from an audit performed by the department to a party that has requested an audit under this section in a manner that does not violate confidential or proprietary information laws.
(e) Any provision of a contract entered into, issued, or renewed after June 30, 2020, that violates this section is unenforceable.
As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.81.