Terms Used In Indiana Code > Title 27 > Article 1 > Chapter 24.5 - Pharmacy Benefit Managers

• 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.
• Commissioner: means the "insurance commissioner" of this state. See Indiana Code 27-1-2-3
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• contract holder: means :

  Indiana Code 27-1-24.5-0.7

• covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 27-1-24.5-1
• Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
• effective rate of reimbursement: includes the following:

  Indiana Code 27-1-24.5-2

• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• equal access and incentives: means that a pharmacy benefit manager allows any willing pharmacy provider to participate as part of any of the pharmacy benefit manager's networks as long as the pharmacy provider agrees to the terms and conditions of the relevant contract applicable to any other pharmacy provider within that network. See Indiana Code 27-1-24.5-3
• generic drug: means a drug product that is identified by the drug's chemical name and that is:

  Indiana Code 27-1-24.5-4

• health plan: means the following:

  Indiana Code 27-1-24.5-5

• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• independent pharmacies: means pharmacies that are not a pharmacy benefit manager affiliate. See Indiana Code 27-1-24.5-6
• Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. See Indiana Code 27-1-2-3
• 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
• 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
• maximum allowable cost list: means a list of drugs that is used:

  Indiana Code 27-1-24.5-8

• 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
• pharmacist: means an individual licensed as a pharmacist under IC 25-26. See Indiana Code 27-1-24.5-9
• pharmacist services: means products, goods, and services provided as part of the practice of pharmacy. See Indiana Code 27-1-24.5-10
• 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

• pharmacy benefit manager affiliate: means a pharmacy or pharmacist that directly or indirectly, through one (1) or more intermediaries:

  Indiana Code 27-1-24.5-13

• pharmacy services administrative organization: means an organization that assists independent pharmacies and pharmacy benefit managers or health plans to achieve administrative efficiencies, including contracting and payment efficiencies. See Indiana Code 27-1-24.5-15
• rebate: means a discount or other price concession that is:

  Indiana Code 27-1-24.5-16

• third party: means a person other than a:

  Indiana Code 27-1-24.5-17

• Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5