Connecticut Administrative Code
Title 38a - Insurance Department
513 - Group Specified Disease Health Insurance Minimum Standards
Section 38a-513-6 - Minimum standards for drug formularies
Current through March 14, 2024
No individual or group health insurance plan or certificate that offers prescription drug coverage that is subject to a formulary shall be delivered or issued for delivery in this state if the formulary does not meet the following required minimum standards:
(1) The formulary shall be easily searchable and posted online, accessible to members and non-members.
(2) The medications within the formulary shall be grouped in alphabetical order by therapeutic class.
(3) Definitions or explanations, or both, of each prescription drug tier, including specialty drug tiers, shall be clearly stated.
(4) Definitions for utilization controls, including, but not limited to, quantity or dosage controls, prior authorization, and step therapy shall be clearly stated.
(5) Tier coverage and utilization controls for each medication (by dosage, if applicable) shall be clearly stated.
(6) The formulary shall include information on how to obtain drugs that are off formulary.
(7) The formulary shall specify if and how drugs may be obtained through mail order pharmacy.
(8) The formulary shall clearly state when it was created, when it was last updated, and when the next anticipated update will be.
(9) The formulary shall provide customer service contact information.
(10) The formulary shall meet all additional requirements set forth by the Commissioner.
