Sec. 20. (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.

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