Indiana Code 27-1-3.7-3. State employee health plan audit and Medicaid audit; request for proposal; contract requirements
(1) Prescription drug cost sharing.
Terms Used In Indiana Code 27-1-3.7-3
- Attorney: includes a counselor or other person authorized to appear and represent a party in an action or special proceeding. See Indiana Code 1-1-4-5
- Contract: A legal written agreement that becomes binding when signed.
- Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
- Fraud: Intentional deception resulting in injury to another.
- Medicaid audit: refers to the audit required by Indiana Code 27-1-3.7-1
- 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
- state employee health plan: refers to the following plans that provide coverage for prescription drugs:
Indiana Code 27-1-3.7-2
(3) Patient steering.
(4) Proper brand and generic definitions.
(5) Effective rate clawbacks.
(6) Medical loss ratio inflation.
(7) Formulary compliance.
(8) Discriminatory pricing.
(9) Specialty drug definition and categorization.
(10) Adherence to contracted pricing terms.
(11) Adherence to plan design, including:
(A) quantity limits; and
(B) prior authorization guidelines.
(12) Under market reimbursements to pharmacies.
(13) Dispensing fees.
(14) Lesser of logic pricing.
(15) Fraud, waste, and abuse.
(16) Rebates.
(17) Compliance with federal law.
(18) Review of practices of any of the following used by the state employee health plan or the Medicaid program:
(A) Managed care organizations.
(B) Pharmacies.
(C) Pharmacy services administrative organizations.
(D) Wholesalers.
(E) Drug manufacturers.
(19) Any other metric determined by the attorney general.
(b) The attorney general may consult with the state personnel department and the office of the secretary of family and social services in:
(1) developing the request for proposal; and
(2) awarding the contract.
(c) If the attorney general decides to issue a request for proposal under this chapter, the attorney general shall develop the request for proposal in a manner that would begin the audit before February 1, 2024.
(d) Any contract between the state personnel department or the office of the secretary of family and social services for the administration of prescription drugs must include a provision to require the person to cooperate with an audit conducted under this chapter and provide the required information to the person awarded the contract for the audit.
As added by P.L.233-2023, SEC.6.