Section 760 IAC 5-4-1 - Maximum allowable cost pricingAuthority: IC 27-1-24.5-20; IC 27-1-24.5-23
Affected: IC 27-1-24.5
Sec. 1.
(a) In a contract between a pharmacy benefit manager and a pharmacy, or a pharmacy benefit manager and a pharmacy services administrative organization, the pharmacy or the pharmacy services administrative organization must be given the right to obtain from the pharmacy benefit manager, within ten (10) calendar days after a request, a current list of the sources used to determine maximum allowable cost pricing. The pharmacy benefit manager must update the maximum allowable cost list at least every seven (7) calendar days and provide a means by which contracted pharmacies and pharmacy services administrative organizations may promptly review maximum allowable cost list updates in a format that is readily available and accessible.(b) A pharmacy benefit manager must maintain a procedure to eliminate products from the list of drugs subject to maximum allowable cost pricing in a timely manner in order to remain consistent with pricing changes in the marketplace.(c) In order to place a prescription drug on a maximum allowable cost list, a pharmacy benefit manager must ensure that: (1) the drug is listed as "A" or "B" rated in the most recent version of the United States Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book, or has an "NR" or "NA" rating or similar rating by a nationally recognized reference; and(2) the drug: (A) is generally available for purchase by pharmacies in Indiana from a national or regional wholesaler licensed and operating in Indiana; and(B) is not obsolete, temporarily unavailable, included on a drug shortage list, or unable to be lawfully substituted.Department of Insurance; 760 IAC 5-4-1; filed 2/23/2023, 9:48 a.m.: 20230322-IR-760220287FRA