Sec. 38a-518f. Mandatory coverage for certain prescription drugs removed from formulary.
Sec. 38a-518f. Mandatory coverage for certain prescription drugs removed
from formulary. Each group 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. 38, 60.)
History: P.A. 99-284 effective January 1, 2000.
See Sec. 38a-492f for similar provisions re individual policies.