Sec. 8. (a) As used in this section, "step therapy protocol" means a protocol that specifies, as a condition of coverage under a health plan, the order in which certain prescription drugs must be used to treat a covered individual's condition. (b) A health plan that denies prior authorization for a prescription drug described in subdivision (1) or (2) shall provide, in the notice of denial, an alternative list of prescription drugs or alternative treatments as follows: (1) If: (A) the prescription drug is not included in the health plan's formulary; and (B) there is at least one (1) alternative prescription drug in the same therapeutic classification (as defined in IC 12-15-35-17.5 ); the alternative list must specify the alternative prescription drugs described in clause (B) that are covered by the health plan. (2) If the prescription drug is prescribed to treat a condition for which coverage under the health plan requires use of a step therapy protocol, the alternative list must specify the alternative prescription drugs or alternative treatments that are required by the step therapy protocol. IC 27-1-37.5 Chapter 37.5. Health Care Service Prior Authorization 27-1-37.5-1 Application of chapter 27-1-37.5-1.5 "Adverse determination" 27-1-37.5-1.6 "Authorization" 27-1-37.5-1.7 "Clinical peer" 27-1-37.5-1.8 "Clinical criteria" 27-1-37.5-1.9 "Cosmetic surgery" 27-1-37.5-2 "Covered individual" 27-1-37.5-3 "CPT code" 27-1-37.5-3.7 "Emergency health care service" 27-1-37.5-3.8 "Episode of care" 27-1-37.5-3.9 "Health care provider" 27-1-37.5-4 "Health care service" 27-1-37.5-5 "Health plan" 27-1-37.5-5.4 "Medically necessary" 27-1-37.5-6 "Participating provider" 27-1-37.5-7 "Prior authorization" 27-1-37.5-8 Repealed 27-1-37.5-8.1 "Urgent health care service" 27-1-37.5-8.3 "Utilization review entity" 27-1-37.5-9 Repealed 27-1-37.5-10 Request for prior authorization; electronic transmission or application programming interface; standardized form 27-1-37.5-11 Repealed 27-1-37.5-12 Claim for which prior authorization was given; denial; resubmission of claim 27-1-37.5-13 Unanticipated, medically necessary health care service 27-1-37.5-13.5 State employee health plan prohibited from requiring prior authorization for certain CPT codes; retroactive denial; review of impact 27-1-37.5-13.7 Limitations on prior authorization requirements for physical therapy or chiropractic visits 27-1-37.5-14 Contrary contract provision void 27-1-37.5-15 Violation of chapter 27-1-37.5-16 Department of insurance; standardized prior authorization form 27-1-37.5-17 Peer to peer review; request 27-1-37.5-19 Publishing prior authorization requirements and restrictions and information about prior authorization approvals and denials; implementing new or amending current prior authorization requirements or restrictions; annual report 27-1-37.5-20 Use of clinical peer when an adverse determination is made or when reviewing or deciding an appeal 27-1-37.5-21 Clinical peer's duty to a covered individual 27-1-37.5-23 Request for prior authorization; process 27-1-37.5-24 Emergency admission or provision of emergency health care services 27-1-37.5-25 Limitation on a utilization review entity's authority to revoke, limit, condition, or restrict an authorization 27-1-37.5-26 Authorization periods 27-1-37.5-27 Utilization review entity's duty to honor certain authorizations 27-1-37.5-28 Automatic authorization for failure to comply with deadlines or requirements
‹ Prev All Indiana sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.