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Indiana Code Title 27. Insurance § 27-13-9-5

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

Sec. 5.  (a) This section applies to a health maintenance organization that provides coverage for prescription drugs or devices and issues a card or other technology for claims processing.

(b) The card or other technology issued by a health maintenance organization must contain uniform prescription drug information that complies with the requirements established under subsection (c).

(c) Prescription drug information cards or other technology must meet either of the following criteria:

(1) Be in a format and contain information fields approved by the National Council for Prescription Drug Programs (NCPDP) as contained in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect on the October 1 most immediately preceding the issuance of the card.

(2) Contain the following information:

(A) The health benefit plan's name.

(B) The enrollee's name, group number, and identification number.

(C) A telephone number to inquire about pharmacy related issues.

(D) The issuer's international identification number or ANSI BIN number, labeled as RxBIN.

(E) The processor control number, labeled as RxPCN.

(F) The insured's pharmacy benefits group number if different than medical group number, labeled as RxGRP.

Only those fields listed in clauses (A) through (F) that are required for proper adjudication of the claim must appear on the card.  If the card is used to adjudicate non-pharmacy claims, then the designation “Rx” listed in clauses (D) through (F) is not required to be used by the issuer.

(d) A health maintenance organization may not be required to issue a prescription drug information card or other technology to a person more than one (1) time during a twelve (12) month period.

(e) The prescription drug information cards or other technology issued under this section may be used for health care service coverage other than the coverage to which this chapter applies.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-13-9-5 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-13-9-5/

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