IC 27-13-38
    Chapter 38. Patient Protection; Drugs and Devices; DrugUtilization Review Program

IC 27-13-38-1
Drug and devices formularies
    Sec. 1. (a) A health maintenance organization may apply aformulary to the prescription drug and devices benefits provided bythe health maintenance organization if the formulary is developed,reviewed, and updated:
        (1) in consultation with; and
        (2) with the approval of;
a pharmacy and therapeutics committee, a majority of whosemembers are licensed physicians.
    (b) If a health maintenance organization maintains one (1) or moredrug and devices formularies, the health maintenance organizationshall do the following:
        (1) Disseminate to participating providers and pharmacists thecomplete drug and devices formulary or formularies maintainedby the health maintenance organization, including a list of thedevices and prescription drugs on the formulary by majortherapeutic category that specifies whether a particular drug ordevice is preferred over other drugs or devices.
        (2) Establish and maintain an expeditious process or procedurethat allows an enrollee to obtain, without penalty or additionalcost sharing beyond that provided for in the enrollee's coveredbenefits with the health maintenance organization, coverage fora specific, medically necessary and appropriate nonformularydrug or device without prior approval from the healthmaintenance organization.
    (c) A health maintenance organization may not:
        (1) void a contract; or
        (2) refuse to renew a contract;
between the health maintenance organization and a prescribingprovider because the prescribing provider has prescribed a medicallynecessary and appropriate nonformulary drug or device as providedin subsection (b)(2).
As added by P.L.69-1998, SEC.16.

IC 27-13-38-2
Substitution of brand name drugs
    Sec. 2. Subject to IC 16-42-22:
        (1) a pharmacist shall not substitute; and
        (2) a health maintenance organization shall not require thesubstitution of;
a different single source brand name drug for a single source brandname drug written on a prescription form or electronicallytransmitted to a pharmacy unless the substitution is approved by theprescribing provider.
As added by P.L.69-1998, SEC.16. Amended by P.L.204-2005,

SEC.20.

IC 27-13-38-3
Drug utilization review programs; contents
    Sec. 3. Each health maintenance organization that has aprescription drug benefit shall establish and operate, or cause to beestablished and operated, a drug utilization review program thatincludes the following:
        (1) Retrospective review of prescription drugs furnished toenrollees.
        (2) Education of physicians, enrollees, and pharmacistsregarding the appropriate use of prescription drugs.
        (3) Ongoing periodic examination of data on outpatientprescription drugs to ensure quality therapeutic outcomes forenrollees.
        (4) Clinically relevant criteria and standards for drug therapy.
        (5) Nonproprietary criteria and standards, developed andrevised through an open, professional consensus process.
        (6) Interventions that focus on improving therapeutic outcomes,including prospective drug utilization review programs thatmonitor for possible prescription drug problems orcomplications, including drug to disease interactions, drug todrug interactions, or therapeutic duplication.
As added by P.L.69-1998, SEC.16.

IC 27-13-38-4
Drug utilization review programs; primary emphasis
    Sec. 4. The primary emphasis of the drug utilization reviewprogram established under section 3 of this chapter is to enhancequality of care for enrollees by assuring appropriate drug therapy.
As added by P.L.69-1998, SEC.16.

IC 27-13-38-5
Drug utilization review programs; confidentiality of enrollees
    Sec. 5. The name of an enrollee that is discovered in the course ofthe drug utilization review program shall remain confidential.
As added by P.L.69-1998, SEC.16.

IC 27-13-38-6
Adoption of rules
    Sec. 6. The commissioner, with input and assistance from the statehealth commissioner, may adopt rules under IC 4-22-2 to implementthis chapter.
As added by P.L.69-1998, SEC.16.