Effective 1-1-2026. 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.
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