Indiana Code
Chapter 24.5. Pharmacy Benefit Managers
27-1-24.5-22.6. Filing Complaints With Department of Insurance

Sec. 22.6. (a) If a pharmacy benefit manager denies an appeal under section 22(a)(2) of this chapter, the appealing contracted pharmacy, pharmacy services administrative organization, or group purchasing organization may file a complaint with the department not later than thirty (30) days from the date of the denial. The department may request additional information from either party as necessary to resolve a complaint.
(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.
(c) A pharmacy benefit manager that receives written notice of a complaint filed under this section shall promptly conduct an investigation of the matters alleged in the complaint. Not later than twenty (20) business days after the date of the complaint, the pharmacy benefit manager shall provide to the department and the complaining party a written report containing the following information:
(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.

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