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Indiana Code Title 27. Insurance § 27-13-38-8

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 8. (a) This section does not apply to a mail order pharmacy or to specialty drugs.

(b) This section applies to an individual contract or a group contract that provides coverage for prescription medications.

(c) As used in this section, “synchronize” means to use a single pharmacy dispensing process as a means of coordinating the enrollee's medications at the same time when:

(1) a particular medication:

(A) is of a formulation that can be effectively split;  and

(B) does not have quantity limits or dose optimization criteria as specified in the individual or group contract's formulary and prior authorization requirements;

(2) the enrollee is on a stabilized treatment plan for a chronic condition and the synchronization is for those drugs treating a chronic condition;  and

(3) the medication is not:

(A) an opioid, stimulant, sedative, or hypnotic medication;  or

(B) another medication that is addictive and subject to abuse.

(d) An individual contract or group contract that provides coverage for prescription drugs may not deny coverage for the refill of any drug prescribed for the treatment of a chronic illness that is made in accordance with a plan between the enrollee and a pharmacist to synchronize the refilling of multiple prescriptions for the enrollee.

(e) An individual contract or a group contract must provide coverage for a medication that is dispensed in a quantity that allows synchronization of the enrollee's medications in accordance with a plan made between the enrollee and the pharmacy to synchronize the enrollee's medications for chronic conditions.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-13-38-8 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-13-38-8/

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