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§ 27-1-37-4-8 — Indiana Law | CourtGPT
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  4. Title 27 - Insurance/
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  6. Chapter 37.4 - Electronic Prescription Drug Prior Authorization27-1-37.4-1. "Covered Individual"/
  7. § 27-1-37-4-8
Indiana Legal Code

§ 27-1-37-4-8

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(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.As added by P.L.246-2019, SEC.23 and P.L.264-2019, SEC.12.