§ 27-13-38-1 — Drug and devices formularies

(a) A health maintenance organization may
apply a formulary to the prescription drug and devices benefits
provided by the health maintenance organization if the formulary is
developed, reviewed, and updated:
(1) in consultation with; and
(2) with the approval of;
a pharmacy and therapeutics committee, a majority of whose members
are licensed physicians.
(b) If a health maintenance organization maintains one (1) or more
drug and devices formularies, the health maintenance organization
shall do the following:
(1) Disseminate to participating providers and pharmacists the
complete drug and devices formulary or formularies maintained
by the health maintenance organization, including a list of the
devices and prescription drugs on the formulary by major
therapeutic category that specifies whether a particular drug or
device is preferred over other drugs or devices.
(2) Establish and maintain an expeditious process or procedure
that allows an enrollee to obtain, without penalty or additional
cost sharing beyond that provided for in the enrollee's covered
benefits with the health maintenance organization, coverage for
a specific, medically necessary and appropriate nonformulary
drug or device without prior approval from the health
maintenance organization.
(c) A health maintenance organization may not:
(1) void a contract; or
(2) refuse to renew a contract;
between the health maintenance organization and a prescribing
provider because the prescribing provider has prescribed a medically
necessary and appropriate nonformulary drug or device as provided in
subsection (b)(2).

Legislative History

As added by P.L.69-1998, SEC.16.