§ 3242. Prescription drug coverage. * (a) Every insurer that delivers\nor issues for delivery in this state a policy that provides coverage for\nprescription drugs shall, with respect to the prescription drug\ncoverage, publish an up-to-date, accurate, and complete list of all\ncovered prescription drugs on its formulary drug list, including any\ntiering structure that it has adopted and any restrictions on the manner\nin which a prescription drug may be obtained, in a manner that is easily\naccessible to insureds and prospective insureds. The formulary drug list\nshall clearly identify the preventive prescription drugs that are\navailable without annual deductibles or coinsurance, including\nco-payments.\n * NB Effective until January 1, 2027\n * (a) Every insurer that delivers or issues for delivery in this state\na policy that provides coverage for prescription drugs shall, with\nrespect to the prescription drug coverage, publish an up-to-date,\naccurate, and complete list of all covered prescription drugs on its\nformulary drug list, including any tiering structure that it has adopted\nand any restrictions on the manner in which a prescription drug may be\nobtained, in a manner that is easily accessible to insureds, prospective\ninsureds, health care providers, and other interested parties. The\nformulary drug list shall clearly identify the preventive prescription\ndrugs that are available without annual deductibles or coinsurance,\nincluding co-payments. A formulary drug list shall only be considered\neasily accessible if:\n (1) it can be viewed on the insurer's public website without requiring\nan individual to create or access an account or enter a password or to\nbe covered under an insurance policy issued by the insurer; and\n (2) an individual can easily discern which formulary drug list applies\nto which plan, if an insurer offers more than one plan.\n * NB Effective January 1, 2027\n (b) (1) Every policy delivered or issued for delivery in this state\nthat provides coverage for prescription drugs shall include in the\npolicy a process that allows an insured, the insured's designee, or the\ninsured's prescribing health care provider to request a formulary\nexception. With respect to the process for such a formulary exception,\nan insurer shall follow the process and procedures specified in article\nforty-nine of this chapter and article forty-nine of the public health\nlaw, except as otherwise provided in paragraphs two, three, four and\nfive of this subsection.\n (2) (A) An insurer shall have a process for an insured, the insured's\ndesignee, or the insured's prescribing health care provider to request a\nstandard review that is not based on exigent circumstances of a\nformulary exception for a prescription drug that is not covered by the\npolicy.\n (B) An insurer shall make a determination on a standard exception\nrequest that is not based on exigent circumstances and notify the\ninsured or the insured's designee and the insured's prescribing health\ncare provider by telephone of its coverage determination no later than\nseventy-two hours following receipt of the request.\n (C) An insurer that grants a standard exception request that is not\nbased on exigent circumstances shall provide coverage of the\nnon-formulary prescription drug for the duration of the prescription,\nincluding refills.\n (D) For the purpose of this subsection, "exigent circumstances" means\nwhen an insured is suffering from a health condition that may seriously\njeopardize the insured's life, health, or ability to regain maximum\nfunction or when an insured is undergoing a current course of treatment\nusing a non-formulary prescription drug.\n (3) (A) An insurer shall have a process for an insured, the insured's\ndesignee, or the insured's prescribing health care provider to request\nan expedited review based on exigent circumstances of a formulary\nexception for a prescription drug that is not covered by the policy.\n (B) An ins
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