Authority: IC 12-17.6-2-11

Affected: IC 12-17.6

Sec. 2. Brand name drugs, where generic substitution is possible, are covered in accordance with applicable law.

1. (1) Brand name drugs are covered if the brand name drug is:

   1. (A) medically necessary; or
   2. (B) less costly than the generic.

2. (2) A brand name drug is medically necessary if the prescriber:

   1. (A) indicates in the prescriber's own handwriting "brand medically necessary" on the prescription or drug order; and
   2. (B) obtains prior authorization by substantiating the medical necessity of the brand name drug as opposed to the less costly generic equivalent. For brand name drugs reimbursable by the office, the prior authorization number assigned to the approved request must be included on the prescription or drug order issued by the prescriber or relayed to the dispensing pharmacist by the prescriber if the prescription is orally transmitted. The office may exempt specific brand name drugs or classes of brand name drugs from the prior authorization requirement.

(Office of the Secretary of Family and Social Services; 405 IAC 13-9-2; filed May 3, 2000, 2:02 p.m.: 23 IR 2237; readopted filed May 22, 2006, 3:22 p.m.: 29 IR 3424; filed Jun 1, 2011, 2:28 p.m.: 20110629-IR-407100420FRA; readopted filed Jun 18, 2012, 11:23 a.m.: 20120718-IR-407120202RFA; readopted filed Apr 9, 2018, 9:12 a.m.: 20180509-IR-405180110RFA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA) NOTE: Transferred from the Office of the Children's Health Insurance Program ( 407 IAC 3-10-2) to the Office of the Secretary of Family and Social Services ( 405 IAC 13-9-2) by P.L.35-2016, SECTION 53, effective March 21, 2016.