Signed by Governor Mike Braun

Vote Smart's Synopsis:

Vote to adopt a conference report and pass a bill that requires PBMs to provide adequate coverage networks, prohibits them from steering business to their own affiliated pharmacies, and requires PBMs to reimburse independent pharmacies at cost, plus a dispensing fee in Indiana.

Highlights:

•  Defines key terms, including (Sec. 1.5, Sec. 11-12): 

• “Actual acquisition cost” as the true net cost paid by a pharmacy for a drug; ○ “Pharmacy benefit manager” (PBM) as a third-party administrator of prescription drug benefits; and 

• “Pharmacy affiliate” as a pharmacy that shares ownership or control with a PBM or insurer. 

• Requires insurers or PBMs to ensure pharmacy networks have reasonable accessibility, including physical pharmacies located no more than 30 miles from patients (Sec. 14).

• Prohibits PBMs from recouping payments to pharmacies after a claim has been paid, unless it is because of fraud or overpayment (Sec. 15).

• Prohibits PBMs from coercing pharmacies to accept terms with affiliated pharmacies or networks (Sec. 15–16). 

• Prohibits PBMs from penalizing pharmacies that inform patients about cheaper or alternative options (Sec. 16). 

• Authorizes patients and pharmacies to file complaints or seek remedies for violations (Sec. 17, 20). 

• Requires transparency in PBM contracts under state employee health plans (Sec. 18).

• Prohibits third-party administrators from requiring employers to enter into a contract with specific PBMs (Sec. 19).

Full Bill Text

Vote Smart's Synopsis:

Vote to adopt a conference report and pass a bill that requires PBMs to provide adequate coverage networks, prohibits them from steering business to their own affiliated pharmacies, and requires PBMs to reimburse independent pharmacies at cost, plus a dispensing fee in Indiana.

Highlights:

•  Defines key terms, including (Sec. 1.5, Sec. 11-12): 

• “Actual acquisition cost” as the true net cost paid by a pharmacy for a drug; ○ “Pharmacy benefit manager” (PBM) as a third-party administrator of prescription drug benefits; and 

• “Pharmacy affiliate” as a pharmacy that shares ownership or control with a PBM or insurer. 

• Requires insurers or PBMs to ensure pharmacy networks have reasonable accessibility, including physical pharmacies located no more than 30 miles from patients (Sec. 14).

• Prohibits PBMs from recouping payments to pharmacies after a claim has been paid, unless it is because of fraud or overpayment (Sec. 15).

• Prohibits PBMs from coercing pharmacies to accept terms with affiliated pharmacies or networks (Sec. 15–16). 

• Prohibits PBMs from penalizing pharmacies that inform patients about cheaper or alternative options (Sec. 16). 

• Authorizes patients and pharmacies to file complaints or seek remedies for violations (Sec. 17, 20). 

• Requires transparency in PBM contracts under state employee health plans (Sec. 18).

• Prohibits third-party administrators from requiring employers to enter into a contract with specific PBMs (Sec. 19).

Full Bill Text