Pub. L. 189-2025 (SEA 140) provides guidance on reimbursements to a pharmacy or pharmacist for a prescription drug or other service. Pursuant to IC 27-1-24.2-15(a)(3), insurers, pharmacy benefit managers (PBM), or other administrators are prohibited from reimbursing a pharmacy or pharmacist for a prescription drug or other service at a net amount that is less than the greater of the following:
(A) the amount the insurer, PBM, or other administrator reimburses itself or a pharmacy affiliate for the same prescription drug by national drug code number or service.
(B) The following amount, as applicable:
(i) If the prescription drug or service is administered, dispensed, or provided at a pharmacy that is a licensed premises (as defined in IC 7.1-1-3-20), the actual acquisition cost for the prescription drug or service plus a fair and reasonable dispensing fee.
(ii) If the prescription drug or service is administered, dispensed, or provided at a pharmacy not described in item (i), the national average drug acquisition cost (NADAC) for the prescription drug or service, as determined by the Centers for Medicare and Medicaid Services (CMS) at the time the prescription drug or service is administered, dispensed, or provided plus a professional dispensing fee equal to the Medicaid fee for service dispensing fee under 405 IAC 5-24-6.
In order to assist in determining the reimbursement amounts pursuant to IC 27-1-24.2-15(a)(3)(B)(i), the following table identifies pharmacies in Indiana that hold both a pharmacy license and an alcohol permit. This table is maintained by the Alcohol and Tobacco Commission (ATC).
The following table identifies pharmacies in Indiana that have both a pharmacy license and an alcohol permit. This table is maintained by the ATC