§ 27-20.8-2 - Pharmacy benefit, limits and co-payments.
SECTION 27-20.8-2
§ 27-20.8-2 Pharmacy benefit, limits andco-payments. – Any health plan that offers pharmacy benefits shall comply with the following:
(a) When a health plan's pharmacy benefit has a dollar limit,the insured's use of such benefit shall be determined based on the healthplan's contracted rate to purchase the drug minus the enrollee's applicableco-payment for covered drugs. The balance will apply towards the enrollee'sdollars limit.
(b) When a health plan charges a co-payment for coveredprescription drugs that is based on a percent of the drug cost, the health planshall disclose within the group policy or individual policy benefitsdescription statement whether the co-payment is based on the plan's contractedrate to purchase the drug or some other cost basis such as retail price.