§ 27-18-50 - Drug coverage.
SECTION 27-18-50
§ 27-18-50 Drug coverage. – (a) Any accident and sickness insurer that utilizes a formulary of medicationsfor which coverage is provided under an individual or group plan mastercontract shall require any physician or other person authorized by thedepartment of health to prescribe medication to prescribe from the formulary. Aphysician or other person authorized by the department of health to prescribemedication shall be allowed to prescribe medications previously on, or not on,the accident and sickness insurer's formulary if he or she believes that theprescription of the non-formulary medication is medically necessary. Anaccident and sickness insurer shall be required to provide coverage for anon-formulary medication only when the non-formulary medication meets theaccident and sickness insurer's medical exception criteria for the coverage ofthat medication.
(b) An accident and sickness insurer's medical exceptioncriteria for the coverage of non-formulary medications shall be developed inaccordance with § 23-17.13-3(c)(3).
(c) Any subscriber who is aggrieved by a denial of benefitsto be provided under this section may appeal the denial in accordance with therules and regulations promulgated by the department of health pursuant tochapter 17.12 of title 23.
(d) This section shall not apply to insurance coverageproviding benefits for: (1) hospital confinement indemnity; (2) disabilityincome; (3) accident only; (4) long term care; (5) Medicare supplement; (6)limited benefit health; (7) specified disease indemnity; (8) sickness or bodilyinjury or death by accident or both; or (9) other limited benefit policies.