IN HB1371

Requires state employee plans, health insurers, and health maintenance organizations to only include generic drugs on maximum allowable cost (MAC) lists if they have FDA "AB" therapeutic equivalence rating with at least one other available drug, are available from Indiana wholesale distributors, and are not obsolete.

Mandates that MAC lists be updated at least once every seven (7) calendar days to reflect market pricing and drug availability, with updated lists forwarded to all participating pharmacies.

Requires all three entities to establish pharmacy appeal procedures allowing pharmacies to file appeals within 15 days of receiving reimbursement notices, with responses required within 15 days.

Specifies that if an appeal is decided in favor of the pharmacy, the entity must adjust reimbursement rates effective immediately, apply the adjustment to all similarly situated pharmacies, and allow rebilling with the original date of service.

Requires entities to provide pharmacies with decision reasons and FDA national drug codes for therapeutically equivalent alternatives available at prices not exceeding the MAC list reimbursement amount if appeals are denied.

Effective July 1, 2016.