Section 12-15-13.6-1 - Audit of Medicaid prescription drug cost sharing; request for proposal(a) Once every three (3) state fiscal years: (1) the state board of accounts; or(2) an independent auditor with experience auditing expenses related to prescription drugs that is hired by the state board of accounts; shall conduct an audit examining prescription drug cost sharing for the Medicaid program.
(b) The attorney general may, for an audit described under IC 27-1-3.7, issue a request for proposal under IC 27-1-3.7 to evaluate and determine whether to include the following in the request for proposal for the audit:(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: (B) prior authorization guidelines.(12) Under market reimbursements to pharmacies.(14) Lesser of logic pricing.(15) Fraud, waste, and abuse.(17) Compliance with federal law.(18) Review of practices of any of the following used within the Medicaid program: (A) Managed care organizations.(C) Pharmacy services administrative organizations.(19) Any other metric determined by the attorney general for inclusion in the audit of the Medicaid program. This subsection expires December 31, 2025.
Amended by P.L. 233-2023,SEC. 1, eff. 5/4/2023.Added by P.L. 196-2021,SEC. 3, eff. 7/1/2021.