Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 10 - HEALTHY INDIANA PLAN
Rule 7 - Benefits and Medical Policy
Section 7-6 - Prescription drug benefits
Universal Citation: 405 IN Admin Code 7-6
Current through September 18, 2024
Authority: 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.
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