Indiana § 27-13-38-8 Application; definitions; denial of coverage to synchronize prohibited;
coverage of synchronization

Indiana Statutes

§ 27-13-38-8 — Application; definitions; denial of coverage to synchronize prohibited; coverage of synchronization

Indiana·Title 27 INSURANCE·Art. 13 HEALTH MAINTENANCE ORGANIZATIONS·Ch. 38 Patient Protection; Drugs and Devices; Drug Utilization

(a)This section does not apply to a mail order pharmacy or to specialty drugs.

(b)This section applies to an individual contract or a group contract that provides coverage for prescription medications.

(c)As used in this section, "synchronize" means to use a single pharmacy dispensing process as a means of coordinating the enrollee's medications at the same time when:

(1)a particular medication:

(A)is of a formulation that can be effectively split; and

(B)does not have quantity limits or dose optimization criteria as specified in the individual or group contract's formulary and prior authorization requirements;

(2)the enrollee is on a stabilized treatment plan for a chronic condition and the synchronization is for those drugs treating a chronic condition; and

(3)the medication is n

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(a) This section does not apply to a mail order
pharmacy or to specialty drugs.
(b) This section applies to an individual contract or a group contract
that provides coverage for prescription medications.
(c) As used in this section, "synchronize" means to use a single
pharmacy dispensing process as a means of coordinating the enrollee's
medications at the same time when:
(1) a particular medication:
(A) is of a formulation that can be effectively split; and
(B) does not have quantity limits or dose optimization criteria
as specified in the individual or group contract's formulary and
prior authorization requirements;
(2) the enrollee is on a stabilized treatment plan for a chronic
condition and the synchronization is for those drugs treating a
chronic condition; and
(3) the medication is not:
(A) an opioid, stimulant, sedative, or hypnotic medication; or
(B) another medication that is addictive and subject to abuse.
(d) An individual contract or group contract that provides coverage
for prescription drugs may not deny coverage for the refill of any drug
prescribed for the treatment of a chronic illness that is made in
accordance with a plan between the enrollee and a pharmacist to
synchronize the refilling of multiple prescriptions for the enrollee.
(e) An individual contract or a group contract must provide
coverage for a medication that is dispensed in a quantity that allows
synchronization of the enrollee's medications in accordance with a plan
made between the enrollee and the pharmacy to synchronize the
enrollee's medications for chronic conditions.

Indiana § 27-13-38-8 (Application; definitions; denial of coverage to synchronize prohibited; coverage of synchronization) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.