Section 405 IAC 10-7-6 - Prescription drug benefitsAuthority: IC 12-15-44.5-9
Affected: IC 12-15-44.5
Sec. 6.
(a) For purposes of prescription drug benefits, HIP Basic and HIP Plus shall cover, at a minimum:(1) one (1) drug in every United States Pharmacopeia category and class; or(2) the same number of prescription drugs in each category and class of the essential health benefits benchmark plan.(b) A HIP Basic member may only access a brand name prescription drug if either: (1) the managed care organization approves a prior authorization request for the brand name drug; or(2) the individual accesses the drug through step therapy.(c) Subject to subsection (d), HIP State Plan Plus and HIP State Plan Basic health plans shall provide prescription drug benefits in accordance with the requirements of legend drugs in the Medicaid fee-for-service program as set forth in 405 IAC 5-24-3.(d) HIP Basic and HIP State Plan Basic prescription drug coverage shall be: (1) limited to no more than a thirty (30) day prescription drug supply; and(2) subject to a copayment in accordance with 405 IAC 10-10-3(c).(e) HIP Plus and HIP State Plan Plus pharmacy benefits include: (1) up to a ninety (90) day prescription supply;(2) mail order pharmacy benefit; and(3) medication therapy management services.Filed 5/18/2015, 12:34 p.m.: 20150617-IR-405140339FRAFiled 1/19/2018, 8:42 a.m.: 20180214-IR-405170484FRAErrata Filed 2/22/2018, 9:36 a.m: 20180307-IR-405180114ACA