Required Prescription Drug Services (Cont’d) Sole Available WAC Plan must cover all FDA-approved prescribed drugs, Drug Therapy medications or drug therapies that are the sole prescription drug available for a covered medical condition. No WAC Prescription drug benefit must not be such that it results or can Unreasonable reasonably be expected to result in an unreasonable restriction Restrictions on on the treatment of patients. Treatment WAC A prescription drug benefit that only covers generic drugs constitutes an unreasonable restriction on the treatment of patients. WAC Prescription drug benefit or formulary must not exclude coverage for a nonformulary drug or medication if the only formulary drug available for an enrollee's covered condition is one that the enrollee cannot tolerate or that is not clinically efficacious for the enrollee. WAC Coverage of Plan must not exclude coverage of any FDA-approved drugs for prescription drug for a particular indication on the grounds that use the drug has not been approved by the FDA for that indication, if it is recognized as effective for treatment of that indication: 450(4)(a)(i) In one of the standard reference compendia;
Required Prescription Drug Services (Cont’d) Sole Available Drug Therapy WAC Plan must cover all FDA-approved prescribed drugs, medications or drug therapies that are the sole prescription drug available for a covered medical condition. No Unreasonable Restrictions on Treatment WAC Prescription drug benefit must not be such that it results or can reasonably be expected to result in an unreasonable restriction on the treatment of patients. WAC A prescription drug benefit that only covers generic drugs constitutes an unreasonable restriction on the treatment of patients. WAC Prescription drug benefit or formulary must not exclude coverage for a nonformulary drug or medication if the only formulary drug available for an enrollee's covered condition is one that the enrollee cannot tolerate or that is not clinically efficacious for the enrollee. Coverage of drugs for use WAC Plan must not exclude coverage of any FDA-approved prescription drug for a particular indication on the grounds that the drug has not been approved by the FDA for that indication, if it is recognized as effective for treatment of that indication: 450(4)(a)(i) In one of the standard reference compendia;
checklist-forms-2018-hcsc-individual-analyst-checklist.docx