{"data":{"id":"us-in/ic-27-1-37.4-8","jurisdiction":"us-in","citation":"IC 27-1-37.4-8","heading":"\"Step therapy protocol\"; notice of denial; required information","body":"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.\n(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:\n(1) If:\n(A) the prescription drug is not included in the health plan's formulary; and\n(B) there is at least one (1) alternative prescription drug in the same therapeutic classification (as defined in IC 12-15-35-17.5);\nthe alternative list must specify the alternative prescription drugs described in clause (B) that are covered by the health plan.\n(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.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 37.4. Electronic Prescription Drug Prior Authorization"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-37.4-8","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"afda84b1a4f121a7ad625988dca20748ba440134c36ffc3ddd589a8cc7bf3ed4","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-37.4-7","next":"us-in/ic-27-1-37.5-1"},"notice":"GroundRules: Original legal text. Not legal advice."}