Section 27-1-24.5-19 - Equal access and incentives; prohibited acts(a) A pharmacy benefit manager shall provide equal access and incentives to all pharmacies within the pharmacy benefit manager's network.(b) A pharmacy benefit manager may not do any of the following:(1) Condition participation in any network on accreditation, credentialing, or licensing of a pharmacy, other than a license or permit required by the Indiana board of pharmacy or other state or federal regulatory authority for the services provided by the pharmacy. However, nothing in this subdivision precludes the department from providing credentialing or accreditation standards for pharmacies.(2) Discriminate against any pharmacy.(3) Directly or indirectly retroactively deny a claim or aggregate of claims after the claim or aggregate of claims has been adjudicated, unless any of the following apply: (A) The original claim was submitted fraudulently.(B) The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the drug.(C) The pharmacist services were not properly rendered by the pharmacy or pharmacist.(4) Reduce, directly or indirectly, payment to a pharmacy for pharmacist services to an effective rate of reimbursement, including permitting an insurer or plan sponsor to make such a reduction.(5) Reimburse a pharmacy that is affiliated with the pharmacy benefit manager, other than solely being included in the pharmacy benefit manager's network, at a greater reimbursement rate than other pharmacies in the same network.(6) Impose limits, including quantity limits or refill frequency limits, on a pharmacy's access to medication that differ from those existing for a pharmacy benefit manager affiliate.(7) Share any covered individual's information, including de-identified covered individual information, received from a pharmacy or pharmacy benefit manager affiliate, except as permitted by the federal Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191). A violation of this subsection by a pharmacy benefit manager constitutes an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.
Amended by P.L. 32-2021,SEC. 78, eff. 7/1/2021.Amended by P.L. 196-2021,SEC. 22, eff. 7/1/2021.Added by P.L. 68-2020,SEC. 1, eff. 7/1/2020.