§ 12-15-35-47 — Review of changes to formulary

(a) This section applies to the following
changes to a formulary used by a managed care organization for
Medicaid recipients:
(1) Removing one (1) or more drugs from the formulary.
(2) Placing new restrictions on one (1) or more drugs on the
formulary.
(b) Before a managed care organization makes a change described
in subsection (a), the managed care organization shall submit the
proposed change to the office.
(c) The office shall forward the proposed change to the board for the
board's review and recommendation.
(d) The office shall provide at least thirty (30) days notification to
the public that the board will:
(1) review the proposed change; and
(2) consider evidence and credible information provided to the
board;
at the board's regular board meeting before making a recommendation
to the office regarding whether the proposed change should be
approved or disapproved.
(e) Based on the final recommendation of the board, the office may
approve or disapprove the proposed change. If a proposed change is not
disapproved within ninety (90) days after the date the managed care
organization submits the proposed change to the office, the managed
care organization may implement the change to the formulary.
(f) A managed care organization:
(1) may add a drug to the managed care organization's formulary
without the approval of the office; and
(2) shall notify the office of any addition to the managed care
organization's formulary within thirty (30) days after making the
addition.

Legislative History

As added by P.L.231-1999, SEC.9. Amended by P.L.152-2017, SEC.30.