Ind. Code § 27-1-37.4-1 "Covered individual"
Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan.
As added by P.L.45-2017, SEC.1.
Ind. Code ch. 27-1-37.4
Ind. Code ch. 27-1-37.4
in effectInd. Code § 27-1-37.4-2 "Health plan"
Sec. 2. As used in this chapter, "health plan" means any of the following that provides coverage for prescription drugs:
(1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1).
(2) A contract with a health maintenance organization (as defined in IC 27-13-1-19).
The term includes a person that administers a policy or contract described in subdivision (1) or (2).
As added by P.L.45-2017, SEC.1.
Ind. Code § 27-1-37.4-3 "Prior authorization"
Sec. 3. As used in this chapter, "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.
As added by P.L.45-2017, SEC.1.
Ind. Code § 27-1-37.4-4 Electronic transmission of prior authorization request
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
(2) dispensing pharmacist;
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.
Ind. Code § 27-1-37.4-5 Application of chapter
Sec. 5. Section 4 of this chapter does not apply if a prescribing health care provider or dispensing pharmacist lacks:
(1) broadband Internet access;
(2) an electronic medical record system; or
(3) a sufficient number of covered individuals as patients or customers, as determined by the commissioner, to warrant the financial expense that compliance with section 4 of this chapter would require.
As added by P.L.45-2017, SEC.1.
Ind. Code § 27-1-37.4-6 Contradictory contract provisions
Sec. 6. A contractual provision that:
(1) is contained in a contract that is entered into, amended, or renewed after December 31, 2017; and
(2) contradicts this chapter;
is void.
As added by P.L.45-2017, SEC.1.
Ind. Code § 27-1-37.4-7 Rulemaking
Sec. 7. The commissioner may adopt rules under IC 4-22-2 to implement this chapter.
As added by P.L.45-2017, SEC.1.
Ind. Code § 27-1-37.4-8 "Step therapy protocol"; notice of denial; required information
Sec. 8. (a) As used in this section, "step therapy protocol" means a protocol that specifies, as a condition of coverage under a health plan, the order in which certain prescription drugs must be used to treat a covered individual's condition.
(b) A health plan that denies prior authorization for a prescription drug described in subdivision (1) or (2) shall provide, in the notice of denial, an alternative list of prescription drugs or alternative treatments as follows:
(1) If:
(A) the prescription drug is not included in the health plan's formulary; and
(B) there is at least one (1) alternative prescription drug in the same therapeutic classification (as defined in IC 12-15-35-17.5);
the alternative list must specify the alternative prescription drugs described in clause (B) that are covered by the health plan.
(2) If the prescription drug is prescribed to treat a condition for which coverage under the health plan requires use of a step therapy protocol, the alternative list must specify the alternative prescription drugs or alternative treatments that are required by the step therapy protocol.
As added by P.L.246-2019, SEC.23 and P.L.264-2019, SEC.12.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026