Cal. Code Regs. tit. 10, § 2594.4 – Prescription Drug Coverage.

(a) An individual or small group health insurance policy shall provide coverage for prescription drugs that complies with all of the following:
1. (1) The sections of the Health and Safety Code enumerated in subdivisions (a)(2)(A)(ii) and (a)(2)(A)(iv) of section 10112.27 of the Insurance Code that apply to prescription drugs.
2. (2) Section 1300.67.24 of Title 28 of the California Code of Regulations.
3. (3) Subsection (a)(1) of section 156.122 of Title 45 of the Code of Federal Regulations.
(b) A health insurer shall submit all of the following to the Commissioner together with a health insurance policy form pursuant to section 10290 of the Insurance Code, and annually on July 1 thereafter:
1. (1) A list reporting the number of chemically distinct prescription drugs covered in each United States Pharmacopeia category and class and an attestation to the truth and accuracy of the list.
2. (2) Any prescription drug list and/or formulary associated with the policy form.
3. (3) Consumer documents describing prescription drug benefits and limitations on coverage, including any prescription drug list and/or formulary associated with the policy form that is provided to consumers.
4. (4) An attestation of compliance with section 1300.67.24 of Title 28 of the California Code of Regulations.

Note: Authority cited: Sections 10112.27, 12921 and 12926, Insurance Code. Reference: Sections 10112.27 and 10290, Insurance Code.

History

1. New section filed 6-13-2013 as an emergency; operative 6-13-2013 (Register 2013, No. 24). A Certificate of Compliance must be transmitted to OAL by 12-10-2013 or emergency language will be repealed by operation of law on the following day.

2. New section refiled 12-9-2013 as an emergency; operative 12-9-2013 (Register 2013, No. 50). Pursuant to Insurance Code section 10112.27(o)(2) a Certificate of Compliance must be transmitted to OAL by 6-9-2014 or emergency language will be repealed by operation of law on the following day.

3. Certificate of Compliance as to 12-9-2013 order transmitted to OAL 1-15-2014 and filed 2-24-2014 (Register 2014, No. 9).

4. Change without regulatory effect amending subsection (a)(3) filed 1-3-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 1).