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Indiana Statutes, Title 12

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Indiana/Statutes

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Title 12, HUMAN SERVICES

328 chapters · 3,181 sections in this title.

All chapters in Title 123,181 Ch 2.1, Service Coordination Services for De…375 Ch 2, Commission on Aging229 Ch 1, Bureau of Aging Services203 Ch 5, Blind Vending Services176 Ch 3, Adult Protective Services138 Ch 4, Division Advisory Council135 Ch 6, Residential Care Assistance113 Ch 7, Adult Guardianship Services108 Ch 8, Institute for Autism105 Ch 14, Representative Payees and Bill Payers101 Ch 13, Long Term Care Ombudsman Program89 Ch 9, Reporting of Blind or Visually Impai…78 Ch 25, Voter Registration Services and Food…78 Ch 12, Managed Care77

12 sections·Filtered byTitle 12✕Ch 35.5✕

Ind. Code § 12-15-35.5-1 Applicability
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Sec. 1. This chapter applies to: (1) the Medicaid program under this article; and (2) the children's health insurance program under IC 12-17.6. As added by P.L.6-2002, SEC.4. Amended by P.L.101-2005, SEC.5.
Ind. Code § 12-15-35.5-10 Determination of eligibility of certain outpatient prescription drugs for rebates
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Sec. 10. (a) As used in this section, "340B covered entity" means an entity authorized to participate in the federal 340B Drug Pricing Program under Section 340B(a)(4) of the federal Public Health Service Act (42 U.S.C. 256b(a)(4)) and includes any pharmacy under contract with th…
Ind. Code § 12-15-35.5-2 "Cross-indicated drug" defined
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Sec. 2. As used in this chapter, "cross-indicated drug" means a drug that is used for a purpose generally held to be reasonable, appropriate, and within the community standards of practice even though the use is not included in the federal Food and Drug Administration's approved …
Ind. Code § 12-15-35.5-2.6 "Waste"
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Sec. 2.6. As used in this chapter, "waste" means inappropriate: (1) overprescribing; (2) underprescribing; (3) overutilization; (4) underutilization; (5) recipient noncompliance with the prescribed regimen; or (6) clinically unjustified utilization; of a prescription drug. As add…

Ind. Code § 12-15-35.5-3 Establishment of prior authorization requirements

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Sec. 3. The office may establish prior authorization requirements for drugs covered under a program described in section 1 of this chapter. As added by P.L.6-2002, SEC.4. Amended by P.L.101-2005, SEC.6; P.L.1-2009, SEC.104; P.L.229-2011, SEC.143; P.L.154-2015, SEC.3; P.L.213-2025…

Ind. Code § 12-15-35.5-4 Prior authorization requirement parameters

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Sec. 4. Prior authorization requirements developed under this chapter must: (1) comply with all applicable state and federal laws, including the provisions of 405 IAC 5-3 and 42 U.S.C. 1396r-8(d)(5); and (2) provide that the prior authorization number assigned to an approved requ…

Ind. Code § 12-15-35.5-5 Prior authorization procedures

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Sec. 5. Before requiring prior authorization for a single source drug, the office shall seek the advice of the drug utilization review board, established by IC 12-15-35-19, at a public meeting of the board. As added by P.L.6-2002, SEC.4.

Ind. Code § 12-15-35.5-6 Publication of prior authorization decision

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Sec. 6. (a) The office shall publish the decision to require prior authorization for a single source drug in a provider bulletin. (b) IC 12-15-13-6 applies to a provider bulletin described in subsection (a). As added by P.L.6-2002, SEC.4.

Ind. Code § 12-15-35.5-7 Limitations on drug refills

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Sec. 7. (a) Subject to subsection (b), the office may place limits on quantities dispensed or the frequency of refills for any covered drug as required by law or for the purpose of: (1) preventing fraud, abuse, or waste; (2) preventing overutilization, inappropriate utilization, …

Ind. Code § 12-15-35.5-7.5 Reimbursement for methadone when prescribed for pain; requirements

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Sec. 7.5. (a) The office may reimburse under Medicaid for methadone if the drug was prescribed for the treatment of pain or pain management only as follows: (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixty (60) milligrams,…

Ind. Code § 12-15-35.5-8 Restriction of mental health drugs for individuals less than 18 years of age

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Sec. 8. In addition to the limits described in section 7 of this chapter, the office may restrict a mental health drug described in section 3 of this chapter that is prescribed for an individual who is less than eighteen (18) years of age if federal financial participation is not…

Ind. Code § 12-15-35.5-9 Reimbursement for drugs indicated only for addiction treatment

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Sec. 9. The office may not reimburse under Medicaid for Subutex, Suboxone, or a similar trade name or generic of the drug if the drug is only indicated for addiction treatment and was prescribed for the treatment of pain or pain management. As added by P.L.37-2016, SEC.2. Amended…