Section 15-856
// EFFECTIVE UNTIL DECEMBER 31, 2022 PER CHAPTERS 29 AND 31 OF 2021 SPECIAL SESSION // (a) (1) In this section the following words have the meanings indicated. (2) “COVID–19” means, interchangeably and collectively, the coronavirus known as COVID–19 or 2019–nCoV and the SARS–CoV–2 virus. (3) (i) “COVID–19 test” means an in vitro diagnostic test for the detection of SARS–CoV–2 […]
Section 15-847 – Coverage for Specialty Drugs
(a) (1) In this section the following words have the meanings indicated. (2) (i) “Complex or chronic medical condition” means a physical, behavioral, or developmental condition that: 1. may have no known cure; 2. is progressive; or 3. can be debilitating or fatal if left untreated or undertreated. (ii) “Complex or chronic medical condition” includes: 1. multiple sclerosis; 2. hepatitis C; and 3. rheumatoid arthritis. (3) “Managed […]
Section 15-847.1 – Copayment or Coinsurance Limits for Certain Drugs — Annual Increase Regulated
(a) This section applies to: (1) insurers and nonprofit health service plans that provide coverage for prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and (2) health maintenance organizations that provide coverage for prescription drugs under individual group contracts that are issued or delivered in the […]
Section 15-848 – Coverage for Ostomy Equipment and Supplies
(a) This section applies to: (1) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and (2) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under […]
Section 15-849 – Coverage for Abuse-Deterrent Opioid Analgesic Drug Products
(a) (1) In this section the following words have the meanings indicated. (2) “Abuse–deterrent opioid analgesic drug product” means a brand name or generic opioid analgesic drug product approved by the U.S. Food and Drug Administration with abuse–deterrent labeling that indicates the drug product is expected to result in a meaningful reduction in abuse. (3) “Opioid analgesic drug product” […]
Section 15-850 – Prior Authorizations for Opioid Antagonist
(a) In this section, “opioid antagonist” means: (1) naloxone hydrochloride; or (2) any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for the treatment of a drug overdose. (b) (1) This section applies to: (i) insurers and nonprofit health service plans that provide coverage for prescription drugs under individual, group, or blanket health insurance […]
Section 15-851 – Prior Authorization for Drug Products to Treat Opioid Use Disorder — Prohibition
(a) (1) This section applies to: (i) insurers and nonprofit health service plans that provide coverage for substance use disorder benefits or prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and (ii) health maintenance organizations that provide coverage for substance use disorder benefits or prescription drugs under […]
Section 15-852 – Prorated Daily Copayment or Coinsurance Amount for Partial Supply of Prescription Drug
(a) (1) In this section the following words have the meanings indicated. (2) “In–network pharmacy” means a pharmacy that is among the participating providers with which an entity subject to this section contracts to provide health care services to members. (3) “Member” means an individual entitled to health care benefits for prescription drugs or devices under a policy issued […]
Section 15-853 – Coverage for Lymphedema Diagnosis, Evaluation, and Treatment
(a) (1) In this section, “gradient compression garment” means a garment that: (i) is used for the treatment of lymphedema; (ii) requires a prescription; and (iii) is custom fit for the individual for whom the garment is prescribed. (2) “Gradient compression garment” does not include disposable medical supplies, including over–the–counter compression or elastic knee–high or other stocking products. (b) This section applies […]
Section 15-854 – Prior Authorization for Prescription Drug
(a) (1) This section applies to: (i) insurers and nonprofit health service plans that provide coverage for prescription drugs through a pharmacy benefit under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and (ii) health maintenance organizations that provide coverage for prescription drugs through a pharmacy benefit under individual or […]