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.
Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.
Terms Used In Indiana Code 27-1-37.4-8
- covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 27-1-37.4-1
- health plan: means any of the following that provides coverage for prescription drugs:
Indiana Code 27-1-37.4-2
- prior authorization: includes a health plan requirement that a prescription drug be authorized for payment by the health plan before the prescription drug is provided to a particular covered individual. See Indiana Code 27-1-37.4-3
(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.
