Section 27-13-15-6 - Right to provide prescription cost information; point of sale cost limit; pharmacist may not be required to collect higher copayment(a) As used in this section, "drug" means a prescription drug.(b) As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for drugs. The term includes the following: (1) A limited service health maintenance organization.(2) A person that administers drug benefits on behalf of a health maintenance organization or a limited service health maintenance organization.(c) As used in this section, "pharmacy" refers to a pharmacist or pharmacy that is a participating provider.(d) A pharmacy or pharmacist shall have the right to provide an enrollee with information concerning the amount of the enrollee's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a health maintenance organization from discussing this information or from selling to the enrollee a more affordable alternative if an affordable alternative is available.(e) A health maintenance organization that covers prescription drugs may not include a provision that requires an enrollee to make payment for a prescription drug at the point of sale in an amount that exceeds the lesser of:(1) the contracted copayment amount; or(2) the amount of total approved charges by the health maintenance organization at the point of sale. This subsection does not prohibit the adjudication of claims in accordance with an individual contract or group contract issued or administered by a health maintenance organization. The enrollee is not liable for any additional charges or entitled to any credits as a result of the adjudicated claim.
(f) The health maintenance organization or a pharmacy benefit manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from an enrollee than the health maintenance organization or pharmacy benefit manager allows the pharmacy or pharmacist to retain.Amended by P.L. 9-2022,SEC. 53, eff. 7/1/2022.Amended by P.L. 114-2020,SEC. 21, eff. 7/1/2020.Added by P.L. 209-2018,SEC. 13, eff. 7/1/2018.