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 copayment for covered drugs. The balance will apply towards the enrollee’s dollar limit. (b) When a health plan charges a copayment 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 copayment is based on the plan’s contracted rate to purchase the drug or some other cost basis such as retail price.
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