TITLE 27
Insurance

CHAPTER 27-20.8
Prescription Drug Benefits

SECTION 27-20.8-2


§ 27-20.8-2 Pharmacy benefit, limits and co-payments.

Any health plan that offers pharmacy benefits shall comply with the following:

(a) When a health plan's pharmacy benefit has a dollar limit, the insured's use of such benefit shall be determined based on the health plan's contracted rate to purchase the drug minus the enrollee's applicable co-payment for covered drugs. The balance will apply towards the enrollee's dollars limit.

(b) When a health plan charges a co-payment for covered prescription drugs that is based on a percent of the drug cost, the health plan shall disclose within the group policy or individual policy benefits description statement whether the co-payment is based on the plan's contracted rate to purchase the drug or some other cost basis such as retail price.

History of Section.
(P.L. 2004, ch. 370, § 1; P.L. 2004, ch. 442, § 1.)