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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle E. BENEFITS PAYABLE UNDER HEALTH COVERAGES |
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Chapter 1369. BENEFITS RELATED TO PRESCRIPTION DRUGS AND DEVICES AND RELATED SERVICES |
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Subchapter B. COVERAGE OF PRESCRIPTION DRUGS SPECIFIED BY DRUG FORMULARY |
Sec. 1369.054. NOTICE AND DISCLOSURE OF CERTAIN INFORMATION REQUIRED
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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.