Section 500.3406o - Insurer providing prescription drug coverage; formulary restrictions.
THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
500.3406o Insurer providing prescription drug coverage; formulary restrictions.
Sec. 3406o.
An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate that provides coverage for prescription drugs and limits those benefits to drugs included in a formulary shall do all of the following:
(a) Provide for participation of participating physicians, dentists, and pharmacists in the development of the formulary.
(b) Disclose to health care providers and upon request to insureds the nature of the formulary restrictions.
(c) Provide for exceptions from the formulary limitation when a nonformulary alternative is a medically necessary and appropriate alternative. This subdivision does not prevent an insurer from establishing prior authorization requirements or another process for consideration of coverage or higher cost-sharing for nonformulary alternatives. Notice as to whether or not an exception under this subdivision has been granted shall be given by the insurer within 24 hours after receiving all information necessary to determine whether the exception should be granted.
History: Add. 1999, Act 177, Imd. Eff. Nov. 16, 1999
Popular Name: Act 218