Indiana § 27-8-10-3.5 Chronic disease and pharmaceutical management programs

Indiana Statutes

§ 27-8-10-3.5 — Chronic disease and pharmaceutical management programs

Indiana § 27-8-10-3.5

Title 27INSURANCE

Art. 8LIFE, ACCIDENT, AND HEALTH

Ch. 10Comprehensive Health Insurance

This text of Indiana § 27-8-10-3.5 (Chronic disease and pharmaceutical management programs) 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 § 27-8-10-3.5 (2026).

Text

5.

(a)The association shall:

(1)approve and implement chronic disease management and pharmaceutical management programs based on:

(A)an analysis of the highest cost health care services covered under association policies;

(B)a review of chronic disease management and pharmaceutical management programs used in populations similar to insureds; and

(C)a determination of the chronic disease management and pharmaceutical management programs expected to best improve health outcomes in a cost effective manner;

(2)consider recommendations of the drug utilization review board established by IC 12-15-35-19 concerning chronic disease management and pharmaceutical management programs;

(3)when practicable, coordinate programs adopted under this section with comparable programs implemented by the

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5. (a) The association shall:
(1) approve and implement chronic disease management and
pharmaceutical management programs based on:
(A) an analysis of the highest cost health care services covered
under association policies;
(B) a review of chronic disease management and
pharmaceutical management programs used in populations
similar to insureds; and
(C) a determination of the chronic disease management and
pharmaceutical management programs expected to best
improve health outcomes in a cost effective manner;
(2) consider recommendations of the drug utilization review
board established by IC 12-15-35-19 concerning chronic disease
management and pharmaceutical management programs;
(3) when practicable, coordinate programs adopted under this
section with comparable programs implemented by the state; and
(4) implement a copayment structure for prescription drugs
covered under an association policy.
(b) A program approved and implemented under this section may
not require prior authorization for a prescription drug that is prescribed
for the treatment of:
(1) human immunodeficiency virus (HIV) or acquired immune
deficiency syndrome (AIDS) and is included on the AIDS drug
assistance program formulary adopted by the Indiana department
of health under the federal Ryan White CARE Act (42 U.S.C.
300ff et seq.); or
(2) hemophilia according to recommendations of the:
(A) Advisory Committee on Blood Safety and Availability of
the United States Department of Health and Human Services;
or
(B) Medical and Scientific Advisory Council of the National
Hemophilia Foundation.
(c) The copayment structure implemented under subsection (a) must
be based on an annual actuarial analysis.
(d) A disease management program for which federal funding is
available is considered to be approved by the association under this
section.
(e) An insured who has a chronic disease for which at least one (1)
chronic disease management program is approved under this section
shall participate in an approved chronic disease management program
for the chronic disease as a condition of coverage of treatment for the
chronic disease under an association policy.