Title 33, Chapter 30, Section 4.3
( 33-30-4.3)
(a) For the purposes of this Code section, the term "health care
insurer" means an insurer, including a fraternal benefit society, a
health care plan, a nonprofit medical service corporation, a
nonprofit hospital service corporation, or a health maintenance
organization authorized to sell accident and sickness insurance
policies, subscriber certificates, or other contracts of accident
and sickness insurance by whatever name called. (b) A group or blanket accident and sickness insurance policy, plan,
contract, or fund may not be issued, delivered, issued for delivery,
or renewed by a health care insurer on or after July 1, 1991, if
such policy, plan, contract, or fund requires that insureds
thereunder obtain pharmaceutical services, including prescription
drugs, exclusively from a mail-order pharmaceutical distributor.
Insureds who do not utilize a mail-order pharmaceutical distributor
shall not be required to pay a different copayment fee or have
imposed any varying conditions for the receipt of pharmaceutical
services, including prescription drugs, when that payment or
condition is not imposed upon those insureds who utilize a
mail-order pharmaceutical distributor for those services if the
provider of pharmaceutical services utilized by the insured has
agreed to the same terms and conditions as applicable to the
mail-order pharmaceutical distributor and has agreed to accept
payment or reimbursement from the health care insurer at no more
than the same amount which would have been paid to the mail-order
pharmaceutical distributor for the same pharmaceutical services. (c) Any health care insurer who issues a group or blanket accident
and sickness policy, plan, contract, or fund that provides coverage
for pharmaceutical services, including prescription drugs, by a
mail-order pharmaceutical distributor shall issue to each insured
under such policy, plan, contract, or fund an explanation of the
payment or reimbursement method applicable to mail-order
pharmaceutical distributors as compared to other providers of
pharmaceutical services. For those health care insurers which
provide benefit booklets to their insureds, the inclusion of such an
explanation in any such benefit booklet shall constitute compliance
with this subsection. (d) Any health care insurer who contracts with a mail-order
pharmaceutical distributor to provide pharmaceutical services,
including prescription drugs, under a group or blanket accident and
sickness policy, plan, contract, or fund shall include in such
contract a provision requiring the mail-order pharmaceutical
distributor in its initial written correspondence with an insured to
include a notice that the insured may obtain pharmaceutical
services, including prescription drugs, from other providers of
pharmaceutical services and that the exclusive utilization of the
mail-order pharmaceutical distributor is not required. (e) A provider of pharmaceutical services who desires to provide
services to insureds in their service area shall, upon written
request to the health care insurer, be provided information
pertaining to the terms and conditions applicable to mail-order
pharmaceutical services available in such service area. If the
provider of pharmaceutical services agrees to such terms and
conditions in writing and agrees to be paid or reimbursed at no more
than the same amount which would be paid to a mail-order
pharmaceutical distributor for the same services, the provider of
pharmaceutical services will be paid or reimbursed at no more than
the same amount paid to the mail-order pharmaceutical distributor
for the same pharmaceutical services. |