IC 27-1-24.5-11.5: "Pharmacy benefit management services"

Sec. 11.5. As used in this chapter, "pharmacy benefit management services" means:

(1) negotiating the price of prescription drugs, including negotiating and contracting for direct or indirect rebates, discounts, or other price concessions;

(2) managing any aspect of a prescription drug benefit, including:

(A) the processing and payment of claims for prescription drugs;

(B) arranging alternative access to or funding for prescription drugs;

(C) the performance of drug utilization review;

(D) the processing of drug prior authorization requests;

(E) the adjudication of appeals or grievances related to the prescription drug benefit;

(F) contracting with network pharmacies;

(G) controlling the cost of covered prescription drugs;

(H) managing or providing data relating to the prescription drug benefit;

(I) the provision of services related to the prescription drug benefit; or

(J) creating or updating prescription drug formularies;

(3) the performance of any administrative, managerial, clinical, pricing, financial, reimbursement, data administration or reporting, or billing service; and

(4) any other services specified in a rule adopted by the department.