Sec. 47. (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.
As added by P.L.231-1999, SEC.9. Amended by P.L.152-2017, SEC.30.
Structure Indiana Code
Chapter 35. Drug Utilization Review
12-15-35-1. "Appropriate and Medically Necessary" Defined
12-15-35-3. "Compendia" Defined
12-15-35-4. "Counseling" Defined
12-15-35-4.5. "Covered Outpatient Drug" Defined
12-15-35-5. "Criteria" Defined
12-15-35-6. "Drug-Disease Contraindication" Defined
12-15-35-7. "Drug-Drug Interaction" Defined
12-15-35-8. "Drug Utilization Review" or "Dur" Defined
12-15-35-9. "Intervention" Defined
12-15-35-10. "Overutilization or Underutilization" Defined
12-15-35-11. "Pharmacist" Defined
12-15-35-12. "Physician" Defined
12-15-35-13. "Prospective Dur" Defined
12-15-35-14. "Retrospective Dur" Defined
12-15-35-15. "Standards" Defined
12-15-35-17. "Therapeutic Appropriateness" Defined
12-15-35-17.5. "Therapeutic Classification" or "Therapeutic Category" Defined
12-15-35-18. "Therapeutic Duplication" Defined
12-15-35-18.5. Application of Chapter
12-15-35-18.7. Formulary Requirements
12-15-35-19. Drug Utilization Review Board; Establishment
12-15-35-20. Membership of Board
12-15-35-20.1. Conflicts of Interest
12-15-35-20.5. Therapeutics Committee Established; Members; Limitations; Terms; Votes; Meetings
12-15-35-21. Board; Appointment; Term
12-15-35-22. Qualifications of Board Members
12-15-35-23. Physician Appointments; Geographic Balance
12-15-35-24. Reappointment of Members
12-15-35-25. Chairman; Compensation; Expenses
12-15-35-27. Retrospective and Prospective Dur Program Responsibility
12-15-35-28. Duties of the Board; Preferred Drug List; Report
12-15-35-28.5. Therapeutics Committee Duties
12-15-35-29. Quorum; Majority Vote on Dur Criteria and Standards for Prescribing
12-15-35-30. Local Practices; Monitoring
12-15-35-31. Intervention; Approval; Requisites
12-15-35-32.1. Annual Report Contents
12-15-35-34. Confidential Identifying Information; Release of Cumulative Nonidentifying Information
12-15-35-35. Prior Approval Program for Outpatient Drugs; Standards
12-15-35-36. Advisory Committees
12-15-35-37. Medicaid State Plan; Inclusion of Retrospective and Prospective Dur Program
12-15-35-38. Dur Program Guidelines and Procedures
12-15-35-39. Retrospective Dur Requisites
12-15-35-40. Prospective Dur Requisites
12-15-35-41. Board Activities Under Ic 34-30-15
12-15-35-43. Confidentiality; Pharmacist Data and Information
12-15-35-44. Confidentiality; Violations; Penalty
12-15-35-45. Outpatient Drug Formulary; Requirements
12-15-35-46. Review of Proposed Formulary
12-15-35-47. Review of Changes to Formulary
12-15-35-48. Board Review of Managed Care Organization Prescription Drug Program
12-15-35-49. Information Provided by Office
12-15-35-50. Maximum Allowable Cost Schedule for Drugs; Pharmacy Participation in Medicaid Program