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2000 SESSION
HB 1111 Prescription drug formularies.
Introduced by: John H. Tate, Jr. | all patrons ... notes | add to my profiles | history
SUMMARY AS PASSED:
Prescription drug formularies. Requires an insurer, corporation, or health maintenance organization that maintains one or more closed drug formularies to establish a process to allow an enrollee to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs in the enrollee's covered benefits, a specific, medically necessary nonformulary prescription drug when the enrollee has been receiving the specific nonformulary prescription drug for at least six months previous to the development or revision of the formulary and the prescribing physician has determined that the formulary drug is an inappropriate therapy for the specific patient or that changing drug therapy presents a significant health risk to the specific patient. After reasonable investigation and consultation with the prescribing physician, the insurer, corporation or health maintenance organization shall act on such requests within one business day of receipt of the request. Substituting an approved generic drug for its branded equivalent does not constitute a change in drug therapy.
SUMMARY AS PASSED HOUSE:
Prescription drug formularies. Requires an insurer, corporation, or health maintenance organization that maintains one or more closed drug formularies to establish a process to allow an enrollee to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs in the enrollee's covered benefits, a specific, medically necessary nonformulary prescription drug when the enrollee has been receiving the specific nonformulary prescription drug for at least six months previous to the development or revision of the formulary and the prescribing physician has determined that the formulary drug is an inappropriate therapy for the specific patient or that changing drug therapy presents a significant health risk to the specific patient. After reasonable investigation and consultation with the prescribing physician, the insurer, corporation or health maintenance organization shall act on such requests within one business day of receipt of the request. Substituting an approved generic drug for its branded equivalent does not constitute a change in drug therapy.
SUMMARY AS INTRODUCED:
Prescription drug formularies. Requires an insurer, corporation, or health maintenance organization that maintains one or more closed drug formularies to establish a process to allow an enrollee to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs in the enrollee's covered benefits, a specific, medically necessary nonformulary prescription drug when the enrollee has been receiving the specific nonformulary prescription drug for at least six months previous to the development or revision of the formulary and the prescribing physician has determined that the formulary drug is an inappropriate therapy for the specific patient or that changing drug therapy presents a significant health risk to the specific patient. After reasonable investigation and consultation with the prescribing physician, the insurer, corporation or health maintenance organization shall act on such requests within one business day of receipt of the request.