Insurance Code § 1369.054

Sec. 1369.054. NOTICE AND DISCLOSURE OF CERTAIN INFORMATION REQUIRED. An issuer of a health benefit plan that covers prescription drugs and uses one or more drug formularies to specify the prescription drugs covered under the plan shall: (1) provide in plain language in the coverage documentation provided to each enrollee: (A) notice that the plan uses one or more drug formularies; (B) an explanation of what a drug formulary is; (C) a statement regarding the method the issuer uses to determine the prescription drugs to be included in or excluded from a drug formulary; (D) a statement of how often the issuer reviews the contents of each drug formulary; and (E) notice that an enrollee may contact the issuer to determine whether a specific drug is included in a particular drug formulary; (2) disclose to an individual on request, not later than the third business day after the date of the request, whether a specific drug is included in a particular drug formulary; and (3) notify an enrollee and any other individual who requests information under this section that the inclusion of a drug in a drug formulary does not guarantee that an enrollee's health care provider will prescribe that drug for a particular medical condition or mental illness. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2011, 82nd Leg., R.S., Ch. 501 (H.B. 1405), Sec. 4, eff. September 1, 2011.