§ 22:1060.2 — Notice and disclosure of certain information required

Louisiana § 22:1060.2

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§1060.2. Notice and disclosure of certain information required
A health insurance issuer of a health benefit plan that covers prescription drugs and
uses one or more drug formularies to specify the prescription drugs covered under the plan
shall do all of the following:
(1) Provide in plain language in the coverage documentation provided to each
enrollee each of the following:
(a) Notice that the plan uses one or more drug formularies.
(b) An explanation of what a drug formulary is.
(c) A statement regarding the method the health insurance issuer uses to determine
the prescription drugs to be included in or excluded from a drug formulary.
(d) A statement of how often the health insurance issuer reviews the contents of each
drug formulary.
(e) Notice, on a form approved by the Department of Insurance, that an enrollee may
contact the health insurance issuer to determine whether a specific drug is included in a
particular drug formulary.
(2) Disclose to an individual upon request, not later than the third business day after
the date of the request, whether a specific drug is included in a particular drug formulary.
(3) Notify an enrollee and any other individual who requests information pursuant
to this Section that the inclusion of a drug in a drug formulary does not guarantee that an
enrollee's physician or other authorized prescriber will prescribe the drug for a particular
medical condition or mental illness.
(4)(a) If a prescribed drug is denied based upon the drug's nonformulary status,
provide the prescriber with a list of the alternative comparable formulary medications in
writing and attached to the letter of denial of prescription drug coverage.
(b) If a prescribed drug is excluded from coverage under the health benefit plan and
other drugs in the same class and used for the same treatment as the excluded drug are
covered under the plan, the issuer or its agent shall notify the prescriber of the covered drug.
(c) It shall be deemed sufficient to meet the requirements of this Paragraph if a health
benefit plan includes the information required by this Paragraph in the denial letter sent by
the health benefit plan or its agent. For any request made by providers utilizing electronic
health records with capabilities, the notice may be sent electronically.
(d) Simple notification of the availability and location of the formulary shall not be
deemed sufficient to meet the requirements of this Paragraph.

Legislative History

Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2019, No. 206, §1, eff. Jan. 1, 2020.