§ 4329. Prescription drug coverage. * (a) Every corporation subject to\nthe provisions of this article that issues a contract that provides\ncoverage for prescription drugs shall, with respect to the prescription\ndrug coverage, 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 corporation subject to the provisions of this article that\nissues a contract that provides coverage for prescription drugs shall,\nwith respect 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 corporation's public website without\nrequiring an individual to create or access an account or enter a\npassword or to be covered under an insurance policy issued by the\ncorporation; and\n (2) an individual can easily discern which formulary drug list applies\nto which plan, if a corporation offers more than one plan.\n * NB Effective January 1, 2027\n (b) (1) Every contract issued by a corporation subject to the\nprovisions of this article that provides coverage for prescription drugs\nshall include in the contract a process that allows an insured, the\ninsured's designee, or the insured's prescribing health care provider to\nrequest a formulary exception. With respect to the process for such a\nformulary exception, a corporation shall follow the process and\nprocedures specified in article forty-nine of this chapter and article\nforty-nine of the public health law, except as otherwise provided in\nparagraphs two, three, four and five of this subsection.\n (2) (A) A corporation shall have a process for an insured, the\ninsured's designee, or the insured's prescribing health care provider to\nrequest a standard review that is not based on exigent circumstances of\na formulary exception for a prescription drug that is not covered by the\ncontract.\n (B) A corporation 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) A corporation 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) A corporation shall have a process for an insured, the\ninsured's designee, or the insured's prescribing health care provider to\nrequest an expedited review based on exigent circumstances of a\nformulary exception fo
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