2024 Indiana Code
Title 12. Human Services
Article 15. Medicaid
Chapter 13.6. Audit of Prescription Drug Cost Sharing
12-15-13.6-1. Audit of Medicaid Prescription Drug Cost Sharing; Request for Proposal
Sec. 1. (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:
(1) Cost sharing.
(2) Spread pricing.
(3) Patient steering.
(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:
(A) quantity limits; and
(B) prior authorization guidelines.
(12) Under market reimbursements to pharmacies.
(13) Dispensing fees.
(14) Lesser of logic pricing.
(15) Fraud, waste, and abuse.
(16) Rebates.
(17) Compliance with federal law.
(18) Review of practices of any of the following used within the Medicaid program:
(A) Managed care organizations.
(B) Pharmacies.
(C) Pharmacy services administrative organizations.
(D) Wholesalers.
(E) Drug manufacturers.
(19) Any other metric determined by the attorney general for inclusion in the audit of the Medicaid program.
This subsection expires December 31, 2025.
As added by P.L.196-2021, SEC.3. Amended by P.L.233-2023, SEC.1.
