Mont. Code Ann. § 33-22-173. Maximum allowable cost or reference price list — appeals process: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2015
If the final determination is a denial of the pharmacy’s appeal, the pharmacy benefit manager shall state the reason for the denial and provide the national drug code of an equivalent drug that is available …
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Mont. Code Ann. § 33-22-174. Opt-out of reference pricing — notification: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2017
Pharmacists or pharmacies in a network plan on referenced based pricing may decline to provide a brand-namedrug, multisource generic drug, supply, or service if the reference pricing amount is less than the acquisition cost paid …
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Mont. Code Ann. § 53-6-1010. Specification for administration on the program: Prescription Drug Plus Discount Program – Montana
Status: Enacted Year Enacted: 2003
The department may use a formulary or other committee to determine preferred drug lists for department programs.
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N.C. Gen. Stat. § 58-3-191. Managed care reporting and disclosure requirements: General Regulations for Insurance – North Carolina
Status: Enacted Year Enacted: 1997
Applies to managed care plans; they must provide the Insurance Commission with reports regarding quality and performance.
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N.C. Gen. Stat. § 58-3-221. Access to nonformulary and restricted access prescription drugs: General Regulations for Insurance – North Carolina
Status: Enacted Year Enacted: 1999
An insurer may not void a contract or refuse to renew a contract between the insurer and a prescribing provider because the prescribing provider has prescribed a medically necessary and appropriate nonformulary or restricted access …
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N.D. Cent. Code § 26.1-36-03.1. Information disclosure: Accident and Health Insurance – North Dakota
Status: Enacted Year Enacted: 1999
An insurer or HMO must disclose a consumer’s payment obligations, the plan’s network design, any utilization review requiements, and other features.
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N.H. Rev. Stat. Ann. §§ 420-E:1, 420-E:4-a, 420-E:5, & 420-E:6: Licensure of Medical Utilization Review Entities – New Hampshire
Status: Enacted Year Enacted: 1992
Beginning July 1, 2017, all health insurers, health maintenance organizations, health services corporations, medical services corporations, and preferred provider programs may, when requiring prior authorization for a prescription drug, use and accept the prior authorization …
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N.M. Stat. § 13-7-15. Prescription drugs; prohibited formulary changes; notice requirements: Health Care Purchasing Act – New Mexico
Status: Enacted Year Enacted: 2013
As of January 1, 2014, group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs categorized or tiered for purposes of …
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N.M. Stat. § 13-7-17. Pharmacy benefits; prescription synchronization: Health Care Purchasing Act – New Mexico
Status: Enacted Year Enacted: 2015
Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers a prescription drug benefit shall allow an enrollee to fill or refill a prescription for …
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N.M. Stat. § 13-7-18. Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions: Health Care Purchasing Act – New Mexico
Status: Enacted Year Enacted: 2018
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs for which any step therapy protocols are required shall establish …
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N.M. Stat. § 13-7-3. Definitions: Health Care Purchasing Act – New Mexico
Status: Enacted Year Enacted: 1997
Provides definitions for the Health Care Purchasing Act, sections 13-7-1 through 13-7-25.
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N.M. Stat. § 59A-22-49.4. Prescription drugs; prohibited formulary changes; notice requirements: Health Insurance Contracts – New Mexico
Status: Enacted Year Enacted: 2013
As of January 1, 2014, an individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides prescription …
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N.M. Stat. § 59A-22-53. Pharmacy benefits; prescription synchronization: Health Insurance Contracts – New Mexico
Status: Enacted Year Enacted: 2015
Allows an insured to fill or request a prescription for less than a thirty-day supply of the prescription drug, and apply a prorated daily copayment or coinsurance for fill or refill.
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N.M. Stat. § 59A-22-53.1. Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions: Health Insurance Contracts – New Mexico
Status: Enacted Year Enacted: 2018
Each individual health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit for which any step therapy protocols are required …
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N.M. Stat. § 59A-23-12.1. Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions: Group and Blanket Health Insurance Contracts – New Mexico
Status: Enacted Year Enacted: 2018
Each group or blanket health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit for which any step therapy protocols …
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N.M. Stat. § 59A-23-7.13. Prescription drugs; prohibited formulary changes; notice requirements: Group and Blanket Health Insurance Contracts – New Mexico
Status: Enacted Year Enacted: 2013
As of January 1, 2014, an individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides prescription …
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