SB579 Summary

• Health benefit plans using drug formularies must provide enrollees with plain language information about formulary use, drug selection methodology, review frequency, and contact procedures for coverage inquiries.

• Plans must disclose within three business days whether a specific drug is included in a formulary and notify patients that formulary inclusion does not guarantee provider prescription.

• Plans must continue offering any previously covered prescription drug at the original benefit level until the plan renewal date, even if the drug is later removed from the formulary.

• Denial of benefits for a non-formulary drug prescribed as medically necessary by a physician constitutes an adverse determination subject to appeal.

• Applies to health benefit plans delivered, issued, or renewed on or after January 1, 2013; takes effect September 1, 2012.