Sec. 24. (a) For every drug for which a pharmacy benefit manager establishes a maximum allowable cost to determine reimbursement for the drug product, the pharmacy benefit manager shall make available to the department, upon request of the department, information that is needed to resolve an appeal.

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Terms Used In Indiana Code 27-1-24.5-24

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
  • maximum allowable cost: means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a generic drug. See Indiana Code 27-1-24.5-7
  • 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

     (b) If the pharmacy benefit manager fails to promptly make available to the department the information as required in subsection (a), the department shall consider the appeal granted in favor of the appealing pharmacy.

As added by P.L.68-2020, SEC.1.

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