No individual health insurance policy that offers prescription drug coverage that is subject to a formulary shall be delivered or issued for delivery in this state if the formulary does not meet the following required minimum standards:
- (1) The formulary shall be easily searchable and posted online, accessible to members and non-members.
- (2) The medications within the formulary shall be grouped in alphabetical order by therapeutic class.
- (3) Definitions or explanations, or both, of each prescription drug tier, including specialty drug tiers, shall be clearly stated.
- (4) Definitions for utilization controls, including, but not limited to, quantity or dosage controls, prior authorization, and step therapy shall be clearly stated.
- (5) Tier coverage and utilization controls for each medication (by dosage, if applicable) shall be clearly stated.
- (6) The formulary shall include information on how to obtain drugs that are off formulary.
- (7) The formulary shall specify if and how drugs may be obtained through mail order pharmacy.
- (8) The formulary shall clearly state when it was created, when it was last updated, and when the next anticipated update will be.
- (9) The formulary shall provide customer service contact information.
- (10) The formulary shall meet all additional requirements as set by the Commissioner.
(Effective December 3, 2018)