Sec. 4. A
health plan shall accept and respond to a request for
prior authorization delivered to the health plan by a
covered individual‘s:
(1) prescribing health care provider; or
Terms Used In Indiana Code 27-1-37.4-4
- covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 27-1-37.4-1
- health plan: means any of the following that provides coverage for prescription drugs:
Indiana Code 27-1-37.4-2
- prior authorization: includes a health plan requirement that a prescription drug be authorized for payment by the health plan before the prescription drug is provided to a particular covered individual. See Indiana Code 27-1-37.4-3
through an electronic transmission that complies with the technical standards developed by the National Council for Prescription Drug Programs for electronic prior authorization transactions (NCPDP SCRIPT).
As added by P.L.45-2017, SEC.1.
