HB 1115 Summary

• Creates a new chapter (IC 27-1-24.5) establishing comprehensive regulatory requirements for pharmacy benefits managers (PBMs) in Indiana, effective July 1, 2014.

• Requires PBMs to owe fiduciary duties to covered entities, including disclosure of conflicts of interest, transfer of financial benefits from drug substitutions and volume-based payments, and provision of all financial and utilization information.

• Mandates that PBMs provide contracted pharmacies with market-based maximum allowable cost (MAC) price lists updated at least every 7 days, ensure MAC prices are not set below market sources, and establish an appeals procedure with 7-day response requirements.

• Prohibits PBMs from placing drugs on MAC price lists unless at least 3 therapeutically equivalent generic alternatives with significant cost differences are available and the drug meets FDA equivalence standards.

• Makes knowing or intentional violations of the chapter a Class B misdemeanor.