§ 26.1-36-43 — Uniform prescription drug information card

1. An insurance company, a nonprofit health service corporation, or a health maintenance
organization that provides coverage for prescription drugs and that issues a card or
other technology for prescription drug claims processing and an administrator of such
coverage, including a third-party administrator for a self-insurance plan, a pharmacy
benefits manager, and a state-administered plan may not deliver, issue, execute, or
renew any health insurance policy, health service contract, or evidence of coverage on
an individual, group, blanket, franchise, or association basis unless the insured is also
issued a uniform card or other technology containing uniform prescription drug
information as provided under this section.
2. The uniform prescription drug information card or other technology must be in the
format approved by the national council for prescription drug programs and must
include all of the fields the issuer determines necessary to submit a claim and all the
fields necessary to conform to the most recent pharmacy information card or
technology implementation guide produced by the national council for prescription
drug programs, or must include all the fields necessary to conform to a national format
acceptable to the commissioner. All information the issuer determines necessary for
claims submission of prescription drug benefits, exclusive of information provided on
the prescription as required by law or rule, must be included on the card or other
technology in a clear, readable, and understandable manner. All information on the
card or other technology which is required under this section and which is not specified
by the national council for prescription drug programs must be formatted and arranged
in a manner that corresponds in content and format acceptable to the commissioner.
All information on the card must be formatted and arranged in a manner that
corresponds in content and format to the current content and format required by the
issuer to process the claim. If an issuer requires a conditional or situation field as
defined by the national council for prescription drug programs, the field must conform
to the pharmacy information card or technology implementation guide produced by the
national council for prescription drug programs or conform to the national format
acceptable to the commissioner.
3. An issuer shall issue a new uniform prescription drug information card or other
technology upon enrollment and reissue upon any change in the cardholder's
coverage which impacts data in content or format as contained on the card or which
affects the data content or format required to be on the card or other technology as
required by this section. Newly issued cards or other technology must be updated with
the latest coverage information and must conform to the national council for
prescription drug programs standards and to the implementation guide or must
conform to the format specified by the commissioner. However, the issuer may issue to
the insured stickers or other methodologies to temporarily update cards as may be
acceptable to the commissioner.
4. The card or other technology may be used for any health insurance coverage. This
section does not require any person issuing the card or other technology to issue a
separate card for prescription coverage, provided the card or other technology can
accommodate the information necessary to process the claim as required by this
section.