Indiana Code 27-1-24.5-12. “Pharmacy benefit manager”
(1) contracts directly or indirectly with pharmacies to provide prescription drugs to individuals;
Terms Used In Indiana Code 27-1-24.5-12
- health plan: means the following:
Indiana Code 27-1-24.5-5
- insurer: means a company, firm, partnership, association, order, society or system making any kind or kinds of insurance and shall include associations operating as Lloyds, reciprocal or inter-insurers, or individual underwriters. See Indiana Code 27-1-2-3
- person: includes individuals, corporations, associations, and partnerships; personal pronoun includes all genders; the singular includes the plural and the plural includes the singular. See Indiana Code 27-1-2-3
- pharmacy: means the physical location:
Indiana Code 27-1-24.5-11
- pharmacy benefit manager: means an entity that, on behalf of a health plan, state agency, insurer, managed care organization, or other third party payor:
Indiana Code 27-1-24.5-12
- third party: means a person other than a:
Indiana Code 27-1-24.5-17
(3) processes or pays pharmacy claims;
(4) creates or updates prescription drug formularies;
(5) makes or assists in making prior authorization determinations on prescription drugs;
(6) administers rebates on prescription drugs; or
(7) establishes a pharmacy network.
(b) The term does not include the following:
(1) A person licensed under IC 16.
(2) A health provider who is:
(A) described in IC 25-0.5-1; and
(B) licensed or registered under IC 25.
(3) A consultant who only provides advice concerning the selection or performance of a pharmacy benefit manager.
As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.77.