IN HB1180

Pharmacy benefit managers (PBMs) must obtain a license from the Indiana Department of Insurance before operating, with the department authorized to establish licensing fees, financial standards, and reporting requirements.

PBMs must provide pharmacy networks within reasonable distance of covered individuals' residences, excluding mail order pharmacies from network adequacy calculations, and submit annual network adequacy reports to the commissioner.

PBMs must report annually to the commissioner on each pharmacy claim, including amounts paid to pharmacies, pharmacy identity, and prescription identification numbers, with all reported information kept confidential.

Health plans that deny prior authorization for prescription drugs must provide patients with an alternative list of covered drugs in the same therapeutic classification or alternative treatments required by step therapy protocols.

The legislative council is urged to assign an interim study committee to examine PBM regulation, including licensure, conflicts of interest, contract provisions limiting pharmacist communications about pricing, and practices regarding wholesale drug distributor requirements.