Sec. 38a-492f. Mandatory coverage for certain prescription drugs removed from formulary.
Sec. 38a-492f. Mandatory coverage for certain prescription drugs removed
from formulary. Each individual health insurance policy providing coverage of the
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered,
issued for delivery, renewed or continued in this state on or after January 1, 2000, that
provides coverage for outpatient prescription drugs shall not deny coverage for an insured for any drug that the insurer removes from its list of covered drugs, or otherwise
ceases to provide coverage for, if (1) the insured was using the drug for the treatment
of a chronic illness prior to the removal or cessation of coverage, (2) the insured was
covered under the policy for the drug prior to the removal or cessation of coverage, and
(3) the insured's attending health care provider states in writing, after the removal or
cessation of coverage, that the drug is medically necessary and lists the reasons why
the drug is more medically beneficial than the drugs on the list of covered drugs. Such
benefits shall be subject to the same terms and conditions applicable to all other benefits
under such policies.
(P.A. 99-284, S. 37, 60.)
History: P.A. 99-284 effective January 1, 2000.
See Sec. 38a-518f for similar provisions re group policies.