1. Except as otherwise provided in this section, a contract for hospital or medical
services which provides coverage for prescription drugs must not limit or exclude
coverage for a drug if the drug:
(a) Had previously been approved for coverage by the insurer for a medical condition
of an insured and the insured's provider of health care determines, after conducting
a reasonable investigation, that none of the drugs which are otherwise currently approved
for coverage are medically appropriate for the insured; and
(b) Is appropriately prescribed and considered safe and effective for treating the
medical condition of the insured.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is prescribed for a use that is different
from the use for which that drug has been approved for marketing by the Food and Drug
(1) The insurer from charging a deductible, copayment or coinsurance for the provision
of benefits for prescription drugs to the insured or from establishing, by contract,
limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from prescribing another drug covered by the contract
that is medically appropriate for the insured; or
(c) Require any coverage for a drug after the term of the contract.
3. Any provision of a contract for hospital or medical services subject to the provisions
of this chapter that is delivered, issued for delivery or renewed on or after October
1, 2001, which is in conflict with this section is void.
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