reglab/housing_qa huggingface dataset:
IN Code § 12-15-35-4.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-4.5. "Covered Outpatient Drug" Defined

Sec. 4.5. As used in this chapter, "covered outpatient drug" has the meaning set forth in 42 U.S.C. 1396r-8(k)(2).As added by P.L.107-2002, SEC.12.
IN Code § 12-15-35-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-5. "Criteria" Defined

Sec. 5. As used in this chapter, "criteria" means the predetermined and explicitly accepted elements that are used to measure drug use on an ongoing basis to determine if the use is appropriate, medically necessary, and not likely to result in adverse medical outcomes.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-6. "Drug-Disease Contraindication" Defined

Sec. 6. As used in this chapter, "drug-disease contraindication" means an occurrence in which the therapeutic effect of a drug is adversely altered by the presence of another disease condition.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-7. "Drug-Drug Interaction" Defined

Sec. 7. As used in this chapter, "drug-drug interaction" means an occurrence in which at least two (2) drugs taken by a recipient leads to clinically significant toxicity that:(1) is characteristic of one (1) or any of the drugs present; or(2) leads to the interference with the effectiveness of one (1) or any of the drugs.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-8. "Drug Utilization Review" or "Dur" Defined

Sec. 8. As used in this chapter, "drug utilization review" or "DUR" means the program designed to measure and assess on a retrospective and a prospective basis the proper use of outpatient drugs in the Medicaid program.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-9. "Intervention" Defined

Sec. 9. As used in this chapter, "intervention" means an action taken by the board with a prescriber or pharmacist to inform about or to influence prescribing or dispensing practices or utilization of drugs.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-10 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-10. "Overutilization or Underutilization" Defined

Sec. 10. As used in this chapter, "overutilization or underutilization" means the use of a drug in such quantities where the desired therapeutic goal is not achieved.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-11 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-11. "Pharmacist" Defined

Sec. 11. As used in this chapter, "pharmacist" means an individual who is licensed as a pharmacist in Indiana under IC 25-26.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-12 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-12. "Physician" Defined

Sec. 12. As used in this chapter, "physician" means an individual who is licensed to practice medicine in Indiana under IC 25-22.5.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-13 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-13. "Prospective Dur" Defined

Sec. 13. As used in this chapter, "prospective DUR" means the part of the drug utilization review program that:(1) is to occur before the drug is dispensed;(2) is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards that are developed on an ongoing basis with professional input; and(3) is to provide for the counseling of recipients about the proper use of drugs.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-14 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-14. "Retrospective Dur" Defined

Sec. 14. As used in this chapter, "retrospective DUR" means the part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards that are developed on an ongoing basis with professional input.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-15 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-15. "Standards" Defined

Sec. 15. As used in this chapter, "standards" means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the Medicaid recipient database.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-16 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-16. "Surs" Defined

Sec. 16. As used in this chapter, "SURS" refers to the surveillance utilization review system of the Medicaid program.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-17 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-17. "Therapeutic Appropriateness" Defined

Sec. 17. As used in this chapter, "therapeutic appropriateness" means drug prescribing based on rational drug therapy that is consistent with the criteria and standards developed under this chapter.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-17.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-17.5. "Therapeutic Classification" or "Therapeutic Category" Defined

Sec. 17.5. As used in this chapter, "therapeutic classification" or "therapeutic category" means a group of pharmacologic agents primarily characterized by a significant similarity of the biochemical or physiological mechanism by which these agents result in the intended clinical outcome.As added by P.L.107-2002, SEC.13.
IN Code § 12-15-35-18 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-18. "Therapeutic Duplication" Defined

Sec. 18. As used in this chapter, "therapeutic duplication" means the prescribing and dispensing of:(1) the same drug; or(2) at least two (2) drugs from the same therapeutic class;where overlapping periods of drug administration are involved and where such prescribing or dispensing is not medically indicated.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-18.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-18.5. Application of Chapter

Sec. 18.5. This chapter applies to any contractor or vendor of the state responsible for providing or managing any part of the Medicaid outpatient drug program.As added by P.L.76-1994, SEC.2.
IN Code § 12-15-35-18.7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-18.7. Formulary Requirements

Sec. 18.7. A formulary established by a managed care organization is subject to sections 46 and 47 of this chapter.As added by P.L.231-1999, SEC.2. Amended by P.L.152-2017, SEC.25.
IN Code § 12-15-35-19 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-19. Drug Utilization Review Board; Establishment

Sec. 19. The drug utilization review board is established.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-20 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-20. Membership of Board

Sec. 20. The board is composed of the following:(1) Four (4) individuals licensed and actively engaged in the practice of medicine or osteopathic medicine in Indiana under IC 25-22.5.(2) Four (4) individuals licensed under IC 25-26 and actively engaged in the practice of pharmacy in Indiana.(3) One (1) individual with expertise in therapeutic pharmacology.(4) A representative of the office who shall serve as an ex-officio nonvoting member of the board.(5) One (1) individual who:(A) is employed by a health maintenance organization that has a pharmacy benefit; and(B) has expertise in formulary development and pharmacy benefit administration.The individual appointed under this subdivision may not be employed by a health maintenance organization that is a managed care organization.(6) One (1) individual with expertise in health economics.As added by P.L.75-1992, SEC.19. Amended by P.L.231-1999, SEC.3; P.L.152-2017, SEC.26; P.L.114-2018, SEC.4.
IN Code § 12-15-35-20.1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-20.1. Conflicts of Interest

Sec. 20.1. (a) Each board member and each therapeutics committee member shall fully disclose any potential conflicts of interest, financial or otherwise, relating to an issue that comes before the board or committee for recommendation or other action.(b) A board member or therapeutics committee member may not vote on a recommendation or other action if the member or the member's employer has a conflict of interest, financial or otherwise, in the outcome of the vote.(c) A board member or therapeutics committee member who may not vote on a recommendation or other action under subsection (b) may still participate in any discussions regarding the recommendation or other action.As added by P.L.231-1999, SEC.4. Amended by P.L.107-2002, SEC.14.
IN Code § 12-15-35-21 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-21. Board; Appointment; Term

Sec. 21. (a) The members of the board shall be appointed by the governor and serve a term of three (3) years.(b) The governor shall fill a vacancy on the board by appointing a new member to serve the remainder of the unexpired term.(c) The governor may remove a member for cause.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-22 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-22. Qualifications of Board Members

Sec. 22. Board members must have expertise in one (1) or more of the following:(1) Clinically appropriate prescribing of outpatient drugs.(2) Clinically appropriate dispensing and monitoring of outpatient drugs.(3) Drug utilization review, evaluation, and intervention.(4) Medical quality assurance.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-23 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-23. Physician Appointments; Geographic Balance

Sec. 23. In making the physician appointments, the governor shall provide for geographic balance.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-24 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-24. Reappointment of Members

Sec. 24. An individual appointed to the board may be reappointed upon the completion of the individual's term.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-25 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-25. Chairman; Compensation; Expenses

Sec. 25. (a) The board shall annually elect a chairman from the members of the board.(b) The chairman may be re-elected to serve consecutive terms as chairman.(c) A member of the board who is not a state employee is entitled to the minimum salary per diem as provided by IC 4-10-11-2.1(b). Each member of the board is entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties as provided in the state travel policies and procedures established by the Indiana department of administration and the budget agency.(d) Each member of the board who is a state employee is entitled to reimbursement for traveling expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-26 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-26. Additional Staff

Sec. 26. (a) The secretary shall provide additional staff to the board.(b) The secretary shall provide staff for the therapeutics committee.As added by P.L.75-1992, SEC.19. Amended by P.L.291-2001, SEC.162; P.L.107-2002, SEC.16.
IN Code § 12-15-35-27 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-27. Retrospective and Prospective Dur Program Responsibility

Sec. 27. The board is responsible for the oversight of the retrospective and prospective DUR program.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-28.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-28.5. Therapeutics Committee Duties

Sec. 28.5. The therapeutics committee established under section 20.5 of this chapter shall do the following:(1) Advise and make recommendations to the board in the board's development and maintenance of a preferred drug list under section 28 of this chapter.(2) Submit to the board a proposed preferred drug list that has been approved by a majority of a quorum of the therapeutics committee.(3) Advise and make recommendations to the board in the board's review and maintenance of a preferred drug list.As added by P.L.107-2002, SEC.18.
IN Code § 12-15-35-28.7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-28.7. Submitting Initial Preferred Drug List; Limitations on Restrictions; Advance Notice to Providers; Implementation; Prior Authorization Limitation; Rules

Sec. 28.7. (a) The board shall submit the initial approved preferred drug list to the office not later than August 1, 2002.(b) Except as permitted under subsection (g), the office may not further restrict the status of a drug in the Medicaid program or the children's health insurance program until the board reviews a therapeutic classification and the office implements the therapeutic classification on the preferred drug list.(c) The office shall provide advance notice to providers of the contents of the preferred drug list submitted by the board under subsection (a).(d) Notwithstanding IC 12-15-13-6, the office shall implement any change in the preferred drug list not later than thirty (30) days after the date the board submits the amended list to the office.(e) Except as provided by section 28(g)(3) of this chapter, the office may not implement a preferred drug list or an amendment to the preferred drug list that has not been approved by the board.(f) The office may not require prior authorization for a drug that is excluded from the preferred drug list unless the board has made the determinations required under section 35 of this chapter.(g) The office may adopt rules under IC 4-22-2 necessary to carry out this chapter.As added by P.L.107-2002, SEC.19. Amended by P.L.184-2003, SEC.8.
IN Code § 12-15-35-29 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-29. Quorum; Majority Vote on Dur Criteria and Standards for Prescribing

Sec. 29. (a) A quorum consists of six (6) voting members of the board.(b) DUR criteria and standards for appropriate prescribing may only be implemented with the approval of a majority of the quorum of the board. The majority vote must include at least three (3) of the four (4) physician members of the board and may allow the board to accept deviations from the standards on a case-by-case basis.As added by P.L.75-1992, SEC.19. Amended by P.L.231-1999, SEC.5.
IN Code § 12-15-35-30 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-30. Local Practices; Monitoring

Sec. 30. The criteria and standards developed under section 28(a)(3) of this chapter for appropriate prescribing that are implemented must reflect the local practices of physicians to monitor the following:(1) Therapeutic appropriateness.(2) Overutilization or underutilization.(3) Therapeutic duplication.(4) Drug-disease contraindications.(5) Drug-drug interactions.(6) Incorrect drug dosage or duration of drug treatment.(7) Clinical abuse and misuse.As added by P.L.75-1992, SEC.19. Amended by P.L.3-2008, SEC.95.
IN Code § 12-15-35-31 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-31. Intervention; Approval; Requisites

Sec. 31. (a) An intervention developed under section 28(a)(4) of this chapter that involves a physician must be approved by at least three (3) of the four (4) physician members of the board before implementation.(b) An intervention that involves a pharmacist must be approved by at least three (3) of the four (4) pharmacist members of the board before implementation.(c) Interventions include the following:(1) Information disseminated to physicians and pharmacists to ensure that physicians and pharmacists are aware of the board's duties and powers.(2) Written, oral, or electronic reminders of recipient-specific or drug-specific information that are designed to ensure recipient, physician, and pharmacist confidentiality, and suggested changes in the prescribing or dispensing practices designed to improve the quality of care.(3) Use of face-to-face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention.(4) Intensified reviews or monitoring of selected prescribers or pharmacists.(5) The creation of an educational program using data provided through DUR to provide for active and ongoing educational outreach programs to improve prescribing and dispensing practices.(6) The timely evaluation of interventions to determine if the interventions have improved the quality of care.(7) The review of case profiles before the conducting of an intervention.As added by P.L.75-1992, SEC.19. Amended by P.L.3-2008, SEC.96.
IN Code § 12-15-35-32.1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-32.1. Annual Report Contents

Sec. 32.1. The annual report under section 28 of this chapter shall include information on the following:(1) A description of the nature and scope of the prospective drug review program.(2) A description of how pharmacies performing prospective DUR without computers are expected to comply with the statutory requirement for written criteria.(3) Detailed information on the specific criteria and standards in use and any changes in criteria.(4) A description of the nature and scope of the retrospective DUR program.(5) A summary of the educational interventions used and an assessment of the effect of these educational interventions on the quality of care.(6) An estimate of the cost savings generated as a result of the DUR program including savings to the Medicaid drug program attributable to the prospective and retrospective DUR.(7) An overview of the fiscal impact of the DUR program on other areas of the Medicaid program.(8) A quantifiable assessment of how DUR has improved quality of care.(9) A summary of the total number of prescriptions reviewed by drug therapeutic class.As added by P.L.76-1994, SEC.4.
IN Code § 12-15-35-34 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-34. Confidential Identifying Information; Release of Cumulative Nonidentifying Information

Sec. 34. (a) Information that identifies an individual collected under this chapter is confidential and may not be disclosed by the board.(b) The board may have access to identifying information for purposes of carrying out intervention activities. The identifying information may not be released to anyone other than a member of the board.(c) The board may release cumulative non-identifying information for purposes of legitimate research.As added by P.L.75-1992, SEC.19.
IN Code § 12-15-35-35 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-35. Prior Approval Program for Outpatient Drugs; Standards

Sec. 35. (a) Except as provided in IC 12-15-35.5-9, before the board develops a program to place a single source drug on prior approval, restrict the drug in its use, or establish a drug monitoring process or program to measure or restrict utilization of single source drugs other than in the SURS program, the board must meet the following conditions:(1) Make a determination, after considering evidence and credible information provided to the board by the office and the public, that placing a single source drug on prior approval or restricting the drug's use will not:(A) impede the quality of patient care in the Medicaid program; or(B) increase costs in other parts of the Medicaid program, including hospital costs and physician costs.(2) Meet to review a formulary or a restriction on a single source drug after the office provides at least fifteen (15) days notification to the public that the board will review the formulary or restriction on a single source drug at a particular board meeting. The notification shall contain the following information:(A) A statement of the date, time, and place at which the board meeting will be convened.(B) A general description of the subject matter of the board meeting.(C) An explanation of how a copy of the formulary to be discussed at the meeting may be obtained.The board shall meet to review the formulary or the restriction on a single source drug at least fifteen (15) days but not more than sixty (60) days after the notification.(3) Ensure that:(A) there is access to at least two (2) alternative drugs within each therapeutic classification, if available, on the formulary; and(B) a process is in place through which a Medicaid recipient has access to medically necessary drugs.(4) Reconsider the drug's removal from its restricted status or from prior approval not later than six (6) months after the single source drug is placed on prior approval or restricted in its use.(5) Ensure that the program provides either telephone or FAX approval or denial Monday through Friday, twenty-four (24) hours a day. The office must provide the approval or denial within twenty-four (24) hours after receipt of a prior approval request. The program must provide for the dispensing of at least a seventy-two (72) hour supply of the drug in an emergency situation or on weekends.(6) Ensure that any prior approval program or restriction on the use of a single source drug is not applied to prevent acceptable medical use for appropriate off-label indications.(b) The board shall advise the office on the implementation of any program to restrict the use of brand name multisource drugs.(c) The board shall consider:(1) health economic data;(2) cost data; and(3) the use of formularies in the non-Medicaid markets;in developing its recommendations to the office.As added by P.L.75-1992, SEC.19. Amended by P.L.76-1994, SEC.5; P.L.231-1999, SEC.6; P.L.6-2002, SEC.3; P.L.107-2002, SEC.20; P.L.1-2003, SEC.58; P.L.37-2016, SEC.1.
IN Code § 12-15-35-36 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 35. Drug Utilization Review|12-15-35-36. Advisory Committees

Sec. 36. The board may establish advisory committees to assist the board in carrying out the board's duties under this chapter.As added by P.L.75-1992, SEC.19.