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 least:

1. (1) one (1) drug in each United States Pharmacopeia category and class; or
2. (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 the:

1. (1) managed care organization approves a prior authorization request for the brand name drug; or
2. (2) 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 under 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 is:

1. (1) limited to not more than a ninety (90) day prescription drug supply; and
2. (2) subject to a copayment under 405 IAC 10-10-3(c).

(e) HIP Plus and HIP State Plan Plus pharmacy benefits include:

1. (1) up to a ninety (90) day prescription supply;
2. (2) a mail order pharmacy benefit; and
3. (3) medication therapy management services.

(Office of the Secretary of Family and Social Services; 405 IAC 10-7-6; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA; filed Jan 19, 2018, 8:42 a.m.: 20180214-IR-405170484FRA; errata filed Feb 22, 2018, 9:36 a.m.: 20180307-IR-405180114ACA; filed Aug 30, 2024, 11:48 a.m.: 20240925-IR-405240182FRA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA)