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1999 SESSION

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HB 2578 Prescription drug formularies.

Introduced by: Viola D. Baskerville | all patrons    ...    notes | add to my profiles

SUMMARY AS PASSED HOUSE: (all summaries)

Prescription drug formularies. Requires any prescription drug formulary applied by any (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis; (ii) corporation providing individual or group accident and sickness subscription contracts; and (iii) health maintenance organization providing a health care plan for health care services to be developed only after consultation and approval by a pharmacy and therapeutics committee. This pharmacy and therapeutics committee will have a majority of its members who are physicians and must also include at least one licensed pharmacist. Additionally, each insurer, corporation, or health maintenance organization maintaining a prescription drug formulary must allow an enrollee to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs within the covered benefits, a specific medically necessary nonformulary prescription drug if, after reasonable investigation and consultation with the prescribing physician, the formulary drug is determined to be an inappropriate therapy for the medical condition of the enrollee. The insurer, corporation, or health maintenance organization must act on such requests within 40 hours of receipt of the request.


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