Ind. Code § 12-15-35.5-1 Applicability
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 ch. 12-15-35.5
Ind. Code ch. 12-15-35.5
in effectInd. Code § 12-15-35.5-2 "Cross-indicated drug" defined
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 labeled indications for the drug.
As added by P.L.6-2002, SEC.4.
Ind. Code § 12-15-35.5-2.5 Repealed
As added by P.L.107-2002, SEC.23. Amended by P.L.184-2003, SEC.10. Repealed by P.L.213-2025, SEC.116.
Ind. Code § 12-15-35.5-2.6 "Waste"
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 added by P.L.11-2010, SEC.2.
Ind. Code § 12-15-35.5-3 Establishment of prior authorization requirements
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, SEC.117.
Ind. Code § 12-15-35.5-4 Prior authorization requirement parameters
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 request be included on the prescription or drug order:
(A) issued by the prescribing practitioner; or
(B) if the prescription is transmitted orally, relayed to the dispensing pharmacist by the prescribing practitioner.
As added by P.L.6-2002, SEC.4. Amended by P.L.107-2002, SEC.24.
Ind. Code § 12-15-35.5-5 Prior authorization procedures
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
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
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, or inappropriate prescription practices that are contrary to:
(A) clinical quality and patient safety; and
(B) accepted clinical practice for the diagnosis and treatment of mental illness and the considerations specified in subsection (h); or
(3) implementing a disease management program.
(b) Before implementing a limit described in subsection (a), the office shall:
(1) consider quality of care and the best interests of Medicaid recipients;
(2) seek the advice of the drug utilization review board, established by IC 12-15-35-19, at a public meeting of the board; and
(3) publish a provider bulletin that complies with the requirements of IC 12-15-13-6.
As added by P.L.6-2002, SEC.4. Amended by P.L.184-2003, SEC.11; P.L.101-2005, SEC.7; P.L.8-2007, SEC.1; P.L.36-2009, SEC.3; P.L.229-2011, SEC.145; P.L.7-2015, SEC.35; P.L.210-2015, SEC.51; P.L.213-2025, SEC.118.
Ind. Code § 12-15-35.5-7.5 Reimbursement for methadone when prescribed for pain; requirements
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, only if:
(A) prior authorization is obtained; and
(B) a determination of medical necessity has been shown by the provider.
(b) A managed care organization may reimburse under Medicaid for methadone if the drug is 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, only if:
(A) prior authorization is obtained; and
(B) a determination of medical necessity has been shown.
As added by P.L.209-2015, SEC.12.
Ind. Code § 12-15-35.5-8 Restriction of mental health drugs for individuals less than 18 years of age
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 available for reimbursement for the prescription under IC 12-15-5-2.
As added by P.L.11-2010, SEC.3.
Ind. Code § 12-15-35.5-9 Reimbursement for drugs indicated only for addiction treatment
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 by P.L.10-2019, SEC.60.
Ind. Code § 12-15-35.5-10 Determination of eligibility of certain outpatient prescription drugs for rebates
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 the entity to dispense drugs on behalf of the entity.
(b) The office of the secretary shall determine whether outpatient prescription drugs prescribed to Medicaid recipients from a 340B covered entity are eligible for rebates under the 340B drug pricing program or whether those prescriptions shall be subject to rebates under the Medicaid drug rebate program under Section 1927 of the federal Social Security Act.
(c) The office of the secretary may adopt rules under IC 4-22-2 and any written policies or procedures as necessary to implement this section.
As added by P.L.213-2025, SEC.119.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026