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.
Structure Indiana Code
Title 5. State and Local Administration
Article 10. Public Employee Benefits
Chapter 8. Group Insurance for Public Employees
5-10-8-0.1. Application of Certain Amendments to Chapter
5-10-8-0.3. Use of Certain Accrued Benefits by State Employees
5-10-8-0.4. Legalization of Certain Payments of Deductible Portion of Group Health Insurance
5-10-8-2.2. Public Safety Employees; Surviving Spouses; Dependents
5-10-8-2.7. Insurance of Rostered Volunteers
5-10-8-4. Discrimination as to Form of Insurance Between Certain Employees; Exception
5-10-8-5. Establishment of Common and Unified Plan of Group Insurance
5-10-8-6.5. General Assembly Members and Former Members
5-10-8-6.7. Election of State Employee Health Care Program by School Corporation
5-10-8-7.1. Coverage for Autism Spectrum Disorder
5-10-8-7.3. Early Intervention Services for First Steps Children
5-10-8-7.5. Prostate Specific Antigen Test
5-10-8-7.7. Surgical Treatment for Morbid Obesity
5-10-8-7.8. Colorectal Cancer Testing Coverage; Exception for High Deductible Health Plans
5-10-8-8. Retired Employees; Ability of Employer to Pay Premiums; Eligibility
5-10-8-8.1. Retired Legislators
5-10-8-8.2. Former Legislators
5-10-8-8.3. Former State and Legislative Employees; Health Benefit Plans
5-10-8-8.4. Revocation or Alteration by Employer
5-10-8-8.5. Establishment of Retiree Health Benefit Trust Fund
5-10-8-9. Coverage of Services for Mental Illness
5-10-8-10. Examining Infants for Hiv; Payment
5-10-8-10.5. Dental Care Provisions Required
5-10-8-11. Use of Diagnostic or Procedure Codes
5-10-8-13. Mail Order or Internet Based Pharmacy
5-10-8-14. Coverage for Prosthetic Devices
5-10-8-14.8. Employee Health Plan Providing Coverage for Prescription Eye Drops
5-10-8-14.9. Coverage of Methadone
5-10-8-15. Coverage for Care Related to Cancer Clinical Trials
5-10-8-16. High Breast Density
5-10-8-16.5. Post-Mastectomy Coverage
5-10-8-17. Step Therapy Protocol
5-10-8-18. Prescription Drug Coverage
5-10-8-19. Prior Authorization
5-10-8-21. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services
5-10-8-22. Coverage for Chronic Pain Management
5-10-8-22.5. Amount Paid for Prescription Drug to Be Counted Against Deductible
5-10-8-23. Reimbursement for Emergency Medical Services
5-10-8-24. Coverage for Pediatric Neuropsychiatric Disorders