TITLE 27
Insurance
CHAPTER 27-19
Nonprofit Hospital Service Corporations
SECTION 27-19-42
§ 27-19-42 Drug coverage.
(a) Any nonprofit hospital service corporation that utilizes a formulary of
medications for which coverage is provided under an individual or group plan
master contract shall require any physician or other person authorized by the
department of health to prescribe medication to prescribe from the formulary. A
physician or other person authorized by the department of health to prescribe
medication shall be allowed to prescribe medications previously on, or not on,
the nonprofit hospital service corporation's formulary if he or she believes
that the prescription of the non-formulary medication is medically necessary. A
nonprofit hospital service corporation shall be required to provide coverage
for a non-formulary medication only when the non-formulary medication meets the
nonprofit hospital service corporation's medical exception criteria for the
coverage of that medication.
(b) A nonprofit hospital service corporation's medical
exception criteria for the coverage of non-formulary medications shall be
developed in accordance with § 23-17.13-3(c)(3).
(c) Any subscriber who is aggrieved by a denial of benefits
to be provided under this section may appeal the denial in accordance with the
rules and regulations promulgated by the department of health pursuant to
chapter 17.12 of title 23.
History of Section.
(P.L. 1998, ch. 290, § 2.)