Prescription drug formulary

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When a healthcare insurer uses a formulary for prescription drugs, the insurer shall include a written procedure whereby covered persons can obtain, without penalty and in a timely fashion, specific drugs and medications not included in the formulary when:

  1. (1) The formulary's equivalent has been ineffective in the treatment of the covered person's disease or condition; or

  2. (2) The formulary's drug causes or is reasonably expected to cause adverse or harmful reactions in the covered person.


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