Indiana § 27-1-37.4-8 "Step therapy protocol"; notice of denial; required information

Indiana Statutes

§ 27-1-37.4-8 — "Step therapy protocol"; notice of denial; required information

Indiana § 27-1-37.4-8

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 37.4Electronic Prescription Drug Prior Authorization

This text of Indiana § 27-1-37.4-8 ("Step therapy protocol"; notice of denial; required information) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-37.4-8 (2026).

Text

(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 th

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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.