INDIANA SUMMARY OF EXISTING LAW

A PBM is prohibited from reducing, 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. A PBM is probhibited from including 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 the contracted copayment amount; or the amount of total approved charges by the PBM at the point of sale.

Link to Existing Law: Ind. Code § 27-1-24.5-1

PRACTICAL NOTE

This is a standard clawback law and prohibits retrospective DIR, GER, BER and similar fees. However, it must be noted that these requirements may be limited to insurance plans regulated by the State, and may exclude Medicare Part D, TRICARE, and ERISA-regulated plans.