reglab/housing_qa huggingface dataset:
IN Code § 27-1-24.5-20 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-20. Acts of the Commissioner; Confidentiality

Sec. 20. (a) The commissioner shall do the following:(1) Prescribe an application for use in applying for a license to operate as a pharmacy benefit manager.(2) Adopt rules under IC 4-22-2 to establish the following:(A) Pharmacy benefit manager licensing requirements.(B) Licensing fees.(C) A license application.(D) Financial standards for pharmacy benefit managers.(E) Reporting requirements described in section 21 of this chapter.(F) The time frame for the resolution of an appeal under section 22 of this chapter.(b) The commissioner may do the following:(1) Charge a license application fee and renewal fees established under subsection (a)(2) in an amount not to exceed five hundred dollars ($500) to be deposited in the department of insurance fund established by IC 27-1-3-28.(2) Examine or audit the books and records of a pharmacy benefit manager one (1) time per year to determine if the pharmacy benefit manager is in compliance with this chapter.(3) Adopt rules under IC 4-22-2 to:(A) implement this chapter; and(B) specify requirements for the following:(i) Prohibited market conduct practices.(ii) Data reporting in connection with violations of state law.(iii) Maximum allowable cost list compliance and enforcement requirements, including the requirements of sections 22 and 23 of this chapter.(iv) Prohibitions and limits on pharmacy benefit manager practices that require licensure under IC 25-22.5.(v) Pharmacy benefit manager affiliate information sharing.(vi) Lists of health plans administered by a pharmacy benefit manager in Indiana.(c) Financial information and proprietary information submitted by a pharmacy benefit manager to the department is confidential.As added by P.L.68-2020, SEC.1.
IN Code § 27-1-24.5-21 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-21. Annual Reporting Requirements; Trade Secrets

Sec. 21. (a) Beginning June 1, 2021, and annually thereafter, a pharmacy benefit manager shall submit a report containing data from the immediately preceding calendar year to the commissioner. The commissioner shall determine what must be included in the report and consider the following information to be included in the report:(1) The aggregate amount of all rebates that the pharmacy benefit manager received from all pharmaceutical manufacturers for:(A) all insurers; and(B) each insurer;with which the pharmacy benefit manager contracted during the immediately preceding calendar year.(2) The aggregate amount of administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers for:(A) all insurers; and(B) each insurer;with which the pharmacy benefit manager contracted during the immediately preceding calendar year.(3) The aggregate amount of retained rebates that the pharmacy benefit manager received from all pharmaceutical manufacturers and did not pass through to insurers with which the pharmacy benefit manager contracted during the immediately preceding calendar year.(4) The highest, lowest, and mean aggregate retained rebate for:(A) all insurers; and(B) each insurer;with which the pharmacy benefit manager contracted during the immediately preceding calendar year.(b) A pharmacy benefit manager that provides information under this section may designate the information as a trade secret (as defined in IC 24-2-3-2). Information designated as a trade secret under this subsection must not be published unless required under subsection (c).(c) Disclosure of information designated as a trade secret under subsection (b) may be ordered by a court of Indiana for good cause shown or made in a court filing.As added by P.L.68-2020, SEC.1.
IN Code § 27-1-24.5-22.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-22.5. Aggregated Information From Pharmacy Benefit Manager Reports

Sec. 22.5. Aggregated information compiled from reports submitted by pharmacy benefit managers to the insurance commissioner under section 22 of this chapter is not confidential except for information that would reveal a specific pharmacy benefit manager's proprietary information.As added by P.L.114-2020, SEC.15.
IN Code § 27-1-24.5-22.6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-22.6. Filing Complaints With Department of Insurance

Sec. 22.6. (a) If a pharmacy benefit manager denies an appeal under section 22(a)(2) of this chapter, the appealing contracted pharmacy, pharmacy services administrative organization, or group purchasing organization may file a complaint with the department not later than thirty (30) days from the date of the denial. The department may request additional information from either party as necessary to resolve a complaint.(b) If a contracted pharmacy or pharmacy services administrative organization believes that its contract with a pharmacy benefit manager contains an unlawful contractual provision regarding reimbursement rates, the contracted pharmacy or pharmacy services administrative organization may file a complaint with the department.(c) A pharmacy benefit manager that receives written notice of a complaint filed under this section shall promptly conduct an investigation of the matters alleged in the complaint. Not later than twenty (20) business days after the date of the complaint, the pharmacy benefit manager shall provide to the department and the complaining party a written report containing the following information:(1) The specific actions taken by the pharmacy benefit manager with respect to:(A) the appeal, for a complaint filed under subsection (a); or(B) the contract, for a complaint filed under subsection (b).(2) A good faith estimate of the time required for a resolution of the complaint.(d) If a pharmacy believes that its contract with a pharmacy services administrative organization contains an unlawful contractual provision regarding reimbursement rates, the pharmacy may file a complaint with the department.(e) The department shall establish a process for complaints filed under this section.As added by P.L.196-2021, SEC.25.
IN Code § 27-1-24.5-23 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-23. Drug Price Data

Sec. 23. (a) For every drug for which the pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the pharmacy benefit manager shall make available to a contracted pharmacy services administrative organization to make available to the pharmacies, or to a pharmacy if the pharmacy benefit manager contracts directly with a pharmacy, in a manner established by the department by administrative rule described in subsection (b) the following:(1) Information identifying the national drug pricing compendia or sources used to obtain the drug price data.(2) The comprehensive list of drugs subject to maximum allowable cost and the actual maximum allowable cost for each drug.(b) The department shall adopt rules under IC 4-22-2 concerning the manner in which a pharmacy benefit manager shall communicate the following to contracted pharmacy services administrative organizations:(1) Drug price data should be used to establish drug reimbursements by pharmacy benefit managers as described in subsection (a)(1).(2) The comprehensive list of drugs described in subsection (a)(2).(c) The department may, concerning a maximum allowable cost list, consider whether a drug is:(1) obsolete;(2) temporarily unavailable;(3) to be included on a drug shortage list; or(4) unable to be lawfully substituted.As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.80.
IN Code § 27-1-24.5-24 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-24. Information Necessary for Appeal

Sec. 24. (a) For every drug for which a pharmacy benefit manager establishes a maximum allowable cost to determine reimbursement for the drug product, the pharmacy benefit manager shall make available to the department, upon request of the department, information that is needed to resolve an appeal.(b) If the pharmacy benefit manager fails to promptly make available to the department the information as required in subsection (a), the department shall consider the appeal granted in favor of the appealing pharmacy.As added by P.L.68-2020, SEC.1.
IN Code § 27-1-24.5-25 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-25. Party's Right to Audit; Amounts Paid; Consideration

Sec. 25. (a) A party that has contracted with a pharmacy benefit manager to provide services may, at least one (1) time in a calendar year, request an audit of compliance with the contract. The audit may include full disclosure of rebate amounts secured on prescription drugs, whether product specific or general rebates, that were provided by a pharmaceutical manufacturer and any other revenue and fees derived by the pharmacy benefit manager from the contract. A contract may not contain provisions that impose unreasonable fees or conditions that would severely restrict a party's right to conduct an audit under this subsection.(b) A pharmacy benefit manager shall disclose, upon request from a party that has contracted with a pharmacy benefit manager, to the party the actual amounts paid by the pharmacy benefit manager to any pharmacy.(c) A pharmacy benefit manager shall provide notice to a party contracting with the pharmacy benefit manager of any consideration that the pharmacy benefit manager receives from a pharmacy manufacturer for any name brand dispensing of a prescription when a generic or biologically similar product is available for the prescription.(d) The commissioner may establish a procedure to release information from an audit performed by the department to a party that has requested an audit under this section in a manner that does not violate confidential or proprietary information laws.(e) Any provision of a contract entered into, issued, or renewed after June 30, 2020, that violates this section is unenforceable.As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.81.
IN Code § 27-1-24.5-26 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-26. Disclosure of Contract With Another Party

Sec. 26. A person or entity that has contracted with a pharmacy benefit manager for the performance of services described in section 12(a) of this chapter is entitled to full disclosure from the pharmacy benefit manager of the terms of a contract between the pharmacy benefit manager and any other person or entity within the same network concerning the performance of the services described in section 12(a) of this chapter, including:(1) the purchase price for prescription drugs within the same network and set by a contract entered into by the pharmacy benefit manager; and(2) the amount of any rebate provided in connection with the purchase of prescription drugs within the same network by a contract entered into by the pharmacy benefit manager.As added by P.L.68-2020, SEC.1.
IN Code § 27-1-24.5-27 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-27. Contracts of Pharmacy Services Administrative Organizations

Sec. 27. A pharmacy services administrative organization shall, upon request, fully disclose to an independent pharmacy on whose behalf the pharmacy services administrative organization acts the terms of a contract between the pharmacy services administrative organization and any other person or entity concerning the actions taken by the pharmacy services administrative organization on behalf of the independent pharmacy.As added by P.L.68-2020, SEC.1.
IN Code § 27-1-24.5-27.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-27.5. Pharmacist May Not Be Required to Collect Higher Copayment for Prescription Drug

Sec. 27.5. A pharmacy benefit manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from a customer than the pharmacy benefit manager allows the pharmacy or pharmacist to retain.As added by P.L.114-2020, SEC.16. Amended by P.L.32-2021, SEC.82.
IN Code § 27-1-24.5-28 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 24.5. Pharmacy Benefit Managers|27-1-24.5-28. Violation of Chapter

Sec. 28. (a) A violation of this chapter is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.(b) The department may also adopt rules under IC 4-22-2 to set forth fines for a violation under this chapter.As added by P.L.68-2020, SEC.1.
IN Code § 27-1-25-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-2. Written Agreements

Sec. 2. (a) An administrator may act only if there is a written agreement between the administrator and an insurer. This agreement must conform to the requirements of this chapter, which apply to the functions performed by the administrator.(b) An agreement between an administrator and an insurer must be retained by both parties as part of their official records for a period of not less than five (5) years after the termination of the agreement.(c) When a policy is issued to a trustee, a copy of the trust agreement and all amendments to it must be:(1) furnished by the administrator to the insurer with which the administrator has a written agreement; and(2) retained as part of the official records of the administrator for a period of not less than five (5) years after the termination of the trust.(d) The written agreement required under subsection (a) must:(1) include a statement of functions that the administrator will perform on behalf of the insurer;(2) specify the lines, classes, or types of coverage that the administrator is authorized to administer on behalf of the insurer; and(3) contain provisions concerning the standard of underwriting required by the insurer.(e) The commissioner may require any written agreement executed by an administrator and an insurer to be filed with the department at the time the administrator applies for a license under this chapter. The commissioner may require any written agreement executed subsequent to the original issue of the license to the administrator to be filed with the department at the time the administrator is applying for renewal of the license.(f) An administrator or insurer may, with written notice, terminate a written agreement for cause as provided in the written agreement. The insurer may suspend the underwriting authority of the administrator during the pendency of a dispute regarding the cause for termination of the written agreement. The insurer shall fulfill lawful obligations with respect to coverage affected by the written agreement, regardless of a dispute described in this subsection.As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.2; P.L.160-2003, SEC.5.
IN Code § 27-1-25-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-3. Presumptions as to Payment of Premiums and Claims

Sec. 3. (a) If an insurer utilizes the services of an administrator:(1) premiums or charges for coverage paid by or on behalf of the covered individual are considered to have been received by the insurer when paid to the administrator; and(2) claims or return premiums paid by the insurer to the administrator are not considered to have been paid to the covered individual or claimant until the payment is received by the covered individual or claimant.(b) This section does not limit the rights of an insurer against an administrator resulting from the failure of the administrator to make payments to the insurer, covered individuals, or claimants.As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.26-1991, SEC.19; P.L.160-2003, SEC.6.
IN Code § 27-1-25-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-5. Advertising

Sec. 5. An administrator may use advertising relating to the business underwritten by an insurer only to the extent that the advertising has been approved in writing by that insurer before the advertising is used.As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.160-2003, SEC.8.
IN Code § 27-1-25-5.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-5.5. Insurer Responsibilities

Sec. 5.5. (a) If an insurer uses the services of an administrator, the insurer is responsible for:(1) determining the:(A) benefits;(B) premium rates;(C) underwriting criteria; and(D) claims payment procedures;that apply to the coverage; and(2) securing reinsurance.(b) An insurer shall provide to an administrator, with the written agreement required under section 2 of this chapter:(1) the rules that the administrator must follow in administering the coverage, as determined under subsection (a); and(2) the responsibilities of the administrator as to administering the coverage.(c) An insurer that uses the services of an administrator has sole responsibility for the competent administration of benefit programs provided by the insurer.(d) If an administrator administers benefits for more than one hundred (100) covered individuals on behalf of an insurer, the insurer shall, not less than semiannually, review the operations of the administrator. At least one (1) of the semiannual reviews must be an onsite audit of the operations of the administrator.As added by P.L.160-2003, SEC.9.
IN Code § 27-1-25-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-6. Fiduciary Status of Administrator; Fiduciary Accounts

Sec. 6. (a) An administrator is a fiduciary in collecting or returning premiums or charges for the insurer with whom it has a written agreement for administrative services.(b) Funds collected by the administrator shall be immediately remitted to the person entitled to the funds or deposited in a fiduciary account, which shall be established and maintained by the administrator in a federally insured or state insured financial institution.(c) The administrator shall maintain records clearly showing the deposits and withdrawals from the fiduciary account for each insurer with whom it has a written agreement for administrative services. The administrator shall furnish to the insurer:(1) upon the insurer's request, copies of the required records; and(2) at intervals specified in the written agreement, a periodic accounting of transactions performed by the administrator pertaining to the business underwritten by the insurer.(d) Subject to the written agreement required by section 2 of this chapter, withdrawals from the fiduciary account shall only be made for the following:(1) Remittance to an insurer entitled to the funds.(2) Deposit in an account maintained in the name of the insurer with whom the administrator has a written agreement.(3) Transfer to and deposit in a claims paying account, with claims to be paid as required under section 7 of this chapter.(4) Payment to a group policyholder for remittance to the insurer entitled to the funds.(5) Payment to the administrator for its commission, fees, or charges.(6) Remittance of return premiums to the person entitled to the funds.(e) An administrator may not pay any claim with money withdrawn from a fiduciary account established under subsection (b) in which premiums or charges are deposited.As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.4; P.L.26-1991, SEC.20; P.L.160-2003, SEC.10.
IN Code § 27-1-25-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-7. Payment of Claims

Sec. 7. All claims paid by an administrator from funds collected on behalf of an insurer shall be paid:(1) by draft or check; or(2) via electronic payment;as authorized by the insurer.As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.5; P.L.160-2003, SEC.11; P.L.130-2020, SEC.5.
IN Code § 27-1-25-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-8. Administrator Compensation

Sec. 8. (a) An administrator may not enter into an agreement or understanding with an insurer if the effect of the agreement or understanding is to make the amount of a:(1) commission;(2) fee; or(3) charge;that is payable to the administrator contingent on savings effected in the adjustment, settlement, and payment of losses covered by the insurer's obligations.(b) This section does not prevent an administrator from receiving performance based compensation for providing hospital auditing services or other auditing services.As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.26-1991, SEC.21; P.L.160-2003, SEC.12.
IN Code § 27-1-25-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-9. Delivery of Written Communications

Sec. 9. Policies, certificates, booklets, termination notices, or other written communications delivered by an insurer to an administrator for delivery to its covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to do so.As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.160-2003, SEC.13.
IN Code § 27-1-25-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 25. Insurance Administrators|27-1-25-10. Notice of Relationship; Statement of Premiums or Charges

Sec. 10. (a) An administrator having a written agreement with an insurer shall provide written notice, which must first be approved by the insurer, to covered persons advising them of the relationship among the administrator, the covered person, and the insurer.(b) When the administrator collects premiums or charges, the administrator shall state separately the amount of any premium or charge for coverage specified by the insurer to the person paying the premium or charge. Additional charges may not be made for a service to the extent that the charge for the service has been paid by the insurer.(c) The administrator shall disclose to the insurer:(1) charges;(2) fees; and(3) commissions;received by the administrator in connection with the provision of administrative services for the insurer, including fees or commissions paid by insurers that provide reinsurance.As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.6; P.L.160-2003, SEC.14.