31A-22-661. Health benefit plan procedures related to prescription drugs.
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Effective 5/1/2024
31A-22-661. Health benefit plan procedures related to prescription drugs.
(1)As used in this section, "long-term drug" means an enrollee's prescription drug where the prescription has been active for at least 180 days with the health benefit plan.
(a)Except as provided in Subsection (2)(b), before a health benefit plan requires an enrollee to change from a prescribed long-term drug to another drug, the health benefit plan shall:
(i)at least 30 days before the day on which the health benefit plan will require the enrollee to change from the long-term drug to another drug, provide notice that the health benefit plan will require the individual to change to another drug; and
(ii)provide a justification for the change upon request.
(b)Subsection (2)(a) does not apply if:
(i)the change requires the individual to try a generic or a biosimilar of the long-term drug; or
(ii)the long-term drug is not on the health benefit plan's formulary.
(3)A health benefit plan shall provide an enrollee a justification as to why an enrollee must try a certain drug before a health benefit plan will cover a different prescribed drug.
(4)This section does not apply to a drug that is provided under the health benefit plan's medical benefit.
Enacted by Chapter 262 , 2024 General Session