39-71-727. Payment for prescription drugs -- limitations.
256 words·~1 min read·
/mt/title-39/chapter-71/part-7/39-71-727A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
39-71-727 . Payment for prescription drugs -- limitations.
(1)For payment of prescription drugs, an insurer is liable only for the purchase of generic-name drugs if the generic-name product is the therapeutic equivalent of the brand-name drug prescribed by the physician, unless the generic-name drug is unavailable.
(2)If an injured worker prefers a brand-name drug, the worker may pay directly to the pharmacist the difference in the reimbursement rate between the brand-name drug and the generic-name product, and the pharmacist may bill the insurer only for the reimbursement rate of the generic-name drug.
(3)The pharmacist may bill only for the cost of the generic-name product on a signed itemized billing, except if purchase of the brand-name drug is allowed as provided in subsection (1).
(4)When billing for a brand-name drug, the pharmacist shall certify that the generic-name drug was unavailable.
(5)The department shall establish a schedule of fees for prescription drugs.
(6)Except as provided in subsection (8), a pharmacist may not dispense more than a 30-day supply at any one time.
(7)For purposes of this section, the terms "brand name" and "generic name" have the meanings provided in 37-7-502 .
(8)An insurer may not require a worker receiving benefits under this chapter to obtain medications from an out-of-state mail order pharmacy. However, an insurer may authorize up to a 90-day supply of medications from an in-state mail order pharmacy.
(9)The provisions of this section do not apply to an agreement between a preferred provider organization and an insurer.