Indiana § 12-15-35-48 Board review of managed care organization prescription drug program

Indiana Statutes

§ 12-15-35-48 — Board review of managed care organization prescription drug program

Indiana·Art. 15 MEDICAID·Ch. 35 Drug Utilization Review

(a)The board shall review the prescription drug program of a managed care organization that participates in a risk based managed care program at least one (1) time per year. The board's review of a prescription drug program must include the following:

(1)An analysis of the single source drugs requiring prior authorization, including the number of drugs requiring prior authorization in comparison to other managed care organizations' prescription drug programs that participate in the state's Medicaid program.

(2)A determination and analysis of the number and the type of drugs subject to a restriction.

(3)A review of the rationale for:

(A)the prior authorization of a drug described in subdivision

(1); and

(B)a restriction on a drug.

(4)A review of the number of requests a managed care

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(a) The board shall review the prescription
drug program of a managed care organization that participates in a risk
based managed care program at least one (1) time per year. The board's
review of a prescription drug program must include the following:
(1) An analysis of the single source drugs requiring prior
authorization, including the number of drugs requiring prior
authorization in comparison to other managed care organizations'
prescription drug programs that participate in the state's Medicaid
program.
(2) A determination and analysis of the number and the type of
drugs subject to a restriction.
(3) A review of the rationale for:
(A) the prior authorization of a drug described in subdivision
(1); and
(B) a restriction on a drug.
(4) A review of the number of requests a managed care
organization received for prior authorization, including the
number of times prior authorization was approved and the number
of times prior authorization was disapproved.
(5) A review of:
(A) patient and provider satisfaction survey reports; and
(B) pharmacy-related grievance data for a twelve (12) month
period.
(b) A managed care organization described in subsection (a) shall
provide the board with the information necessary for the board to
conduct its review under subsection (a).

Indiana § 12-15-35-48 (Board review of managed care organization prescription drug program) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.