|
2012 -- S 3045 | |
|
======= | |
|
LC02780 | |
|
======= | |
|
STATE OF RHODE ISLAND | |
|
| |
|
IN GENERAL ASSEMBLY | |
|
| |
|
JANUARY SESSION, A.D. 2012 | |
|
| |
|
____________ | |
|
| |
|
A N A C T | |
|
RELATING TO INSURANCE -- PRESCRIPTION DRUGS -- NON FORMULARY | |
|
MEDICATIONS | |
|
|
|
|
|
|
|
Introduced By: Senators Felag, McCaffrey, Ruggerio, Gallo, and Walaska | |
|
Date Introduced: June 05, 2012 | |
|
Referred To: Senate Health & Human Services | |
|
It is enacted by the General Assembly as follows: | |
|
1-1 |
SECTION 1. Section 27-19-42 of the General Laws in Chapter 27-19 entitled "Nonprofit |
|
1-2 |
Hospital Service Corporations" is hereby amended to read as follows: |
|
1-3 |
27-19-42. Drug coverage. -- (a) Any nonprofit hospital service corporation that utilizes a |
|
1-4 |
formulary of medications for which coverage is provided under an individual or group plan |
|
1-5 |
master contract shall require any physician or other person authorized by the department of health |
|
1-6 |
to prescribe medication to prescribe from the formulary. A physician or other person authorized |
|
1-7 |
by the department of health to prescribe medication shall be allowed to prescribe medications |
|
1-8 |
previously on, or not on, the nonprofit hospital service corporation's formulary if he or she |
|
1-9 |
believes that the prescription of the non-formulary medication is medically necessary. A |
|
1-10 |
nonprofit hospital service corporation shall be required to provide coverage for a non-formulary |
|
1-11 |
medication only when the non-formulary medication meets the nonprofit hospital service |
|
1-12 |
corporation's medical exception criteria for the coverage of that medication; provided, however |
|
1-13 |
that a nonprofit medical service corporation shall be required to provide coverage for a non- |
|
1-14 |
formulary medication, regardless of whether said medication meets the nonprofit medical service |
|
1-15 |
corporation's medical exception criteria, if the medication has been prescribed as treatment for |
|
1-16 |
schizophrenia as defined by the most recent edition of the Diagnostic and Statistical Manual of |
|
1-17 |
Mental Disorders (DSM) published by the American Psychiatric Association. |
|
1-18 |
(b) A nonprofit hospital service corporation's medical exception criteria for the coverage |
|
1-19 |
of non-formulary medications shall be developed in accordance with section 23-17.13-3(c)(3). |
|
2-1 |
(c) Any subscriber who is aggrieved by a denial of benefits to be provided under this |
|
2-2 |
section may appeal the denial in accordance with the rules and regulations promulgated by the |
|
2-3 |
department of health pursuant to chapter 17.12 of title 23. |
|
2-4 |
SECTION 2. Section 27-20-37 of the General Laws in Chapter 27-20 entitled "Nonprofit |
|
2-5 |
Medical Service Corporations" is hereby amended to read as follows: |
|
2-6 |
27-20-37. Drug coverage. -- (a) Any nonprofit medical service corporation that utilizes a |
|
2-7 |
formulary of medications for which coverage is provided under an individual or group plan |
|
2-8 |
master contract shall require any physician or other person authorized by the department of health |
|
2-9 |
to prescribe medication to prescribe from the formulary. A physician or other person authorized |
|
2-10 |
by the department of health to prescribe medication shall be allowed to prescribe medications |
|
2-11 |
previously on, or not on, the nonprofit medical service corporation's formulary if he or she |
|
2-12 |
believes that the prescription of the non-formulary medication is medically necessary. A |
|
2-13 |
nonprofit hospital service corporation shall be required to provide coverage for a non-formulary |
|
2-14 |
medication only when the non-formulary medication meets the nonprofit medical service |
|
2-15 |
corporation's medical exception criteria for the coverage of that medication; provided, however |
|
2-16 |
that a nonprofit medical service corporation shall be required to provide coverage for a non- |
|
2-17 |
formulary medication, regardless of whether said medication meets the nonprofit medical service |
|
2-18 |
corporation's medical exception criteria, if the medication has been prescribed as treatment for |
|
2-19 |
schizophrenia as defined by the most recent edition of the Diagnostic and Statistical Manual of |
|
2-20 |
Mental Disorders (DSM) published by the American Psychiatric Association. |
|
2-21 |
(b) A nonprofit medical service corporation's medical exception criteria for the coverage |
|
2-22 |
of non-formulary medications shall be developed in accordance with section 23-17.13-3(c)(3). |
|
2-23 |
(c) Any subscriber who is aggrieved by a denial of benefits to be provided under this |
|
2-24 |
section may appeal the denial in accordance with the rules and regulations promulgated by the |
|
2-25 |
department of health pursuant to chapter 17.12 of title 23. |
|
2-26 |
SECTION 3. This act shall take effect upon passage. |
|
| |
|
======= | |
|
LC02780 | |
|
======= | |
|
EXPLANATION | |
|
OF | |
|
A N A C T | |
|
RELATING TO INSURANCE -- PRESCRIPTION DRUGS -- NON FORMULARY | |
|
MEDICATIONS | |
|
*** | |
|
3-1 |
This act would require nonprofit hospital and medical service corporations to provide |
|
3-2 |
coverage for non-formulary schizophrenia medications. |
|
3-3 |
This act would take effect upon passage. |
|
| |
|
======= | |
|
LC02780 | |
|
======= |