Sec. 48. (a) The board shall review the prescription drug program of a managed care organization that participates in a risk based managed care program at least one (1) time per year. The board's review of a prescription drug program must include the following:
(1) An analysis of the single source drugs requiring prior authorization, including the number of drugs requiring prior authorization in comparison to other managed care organizations' prescription drug programs that participate in the state's Medicaid program.
(2) A determination and analysis of the number and the type of drugs subject to a restriction.
(3) A review of the rationale for:
(A) the prior authorization of a drug described in subdivision (1); and
(B) a restriction on a drug.
(4) A review of the number of requests a managed care organization received for prior authorization, including the number of times prior authorization was approved and the number of times prior authorization was disapproved.
(5) A review of:
(A) patient and provider satisfaction survey reports; and
(B) pharmacy-related grievance data for a twelve (12) month period.
(b) A managed care organization described in subsection (a) shall provide the board with the information necessary for the board to conduct its review under subsection (a).
As added by P.L.107-2002, SEC.22. Amended by P.L.205-2013, SEC.206; P.L.53-2014, SEC.106; P.L.152-2017, SEC.31; P.L.130-2018, SEC.49.
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