2020(5) The issuer must then approve or deny the request within (a)(ii)(C)(II) calendar days of the receipt of the additional information and include the authorization number in its approval. Prescription Publishing 45 CFR Plan must publish an up-to-date, accurate, and complete list of all Drug Services Formulary 156.122(d)(1) covered drugs on its formulary drug list, including any tiering (EHB) structure and any restrictions on the manner in which a drug can be (Cont’d) obtained. List must be in a manner that is easily accessible to plan enrollees, prospective enrollees, the State, the Exchange, HHS, the U.S. Office of Personnel Management, and the general public. 45 CFR 156.122 A formulary drug list is easily accessible when: (d)(1)(i) It can be viewed on the plan's public Web site through a clearly identifiable link or tab without requiring an individual to create or access an account or a policy number; and 156.122 If an issuer offers more than one plan, when an individual can (d)(1)(ii) easily discern which formulary drug list applies to which plan. Access to 45 CFR Plan must have the following access procedures: Prescription 156.122(e)(1) Plan must enrollees to access prescription drug benefits at in-network retail pharmacies, unless: 156.122 The drug is subject to restricted distribution by the U.S. Food (e)(1)(i) and Drug Administration; or 45 CFR 156.122 The drug requires special handling, provider coordination, or (e)(1)(ii) patient education that cannot be provided by a retail pharmacy. 45 CFR Plan may charge enrollees a different cost-sharing amount for 156.122(e)(2) obtaining a covered drug at a retail pharmacy, but all cost sharing will count towards the plan's annual limitation on cost sharing. Oral RCW 48.46.274; Plan must provide coverage for prescribed, administered Chemotherapy WAC anticancer medication on a basis at least comparable to cancer chemotherapy medications administered by a health care provider
2020(5) (a)(ii)(C)(II) The issuer must then approve or deny the request within calendar days of the receipt of the additional information and include the authorization number in its approval. Prescription Drug Services (EHB) (Cont’d) Publishing Formulary 45 CFR 156.122(d)(1) Plan must publish an up-to-date, accurate, and complete list of all covered drugs on its formulary drug list, including any tiering structure and any restrictions on the manner in which a drug can be obtained. List must be in a manner that is easily accessible to plan enrollees, prospective enrollees, the State, the Exchange, HHS, the U.S. Office of Personnel Management, and the general public. 45 CFR 156.122 (d)(1)(i) A formulary drug list is easily accessible when: It can be viewed on the plan's public Web site through a clearly identifiable link or tab without requiring an individual to create or access an account or a policy number; and 156.122 (d)(1)(ii) If an issuer offers more than one plan, when an individual can easily discern which formulary drug list applies to which plan. Access to Prescription 45 CFR 156.122(e)(1) Plan must have the following access procedures: Plan must enrollees to access prescription drug benefits at in-network retail pharmacies, unless: 156.122 (e)(1)(i) The drug is subject to restricted distribution by the U.S. Food and Drug Administration; or 45 CFR 156.122 (e)(1)(ii) The drug requires special handling, provider coordination, or patient education that cannot be provided by a retail pharmacy. 45 CFR 156.122(e)(2) Plan may charge enrollees a different cost-sharing amount for obtaining a covered drug at a retail pharmacy, but all cost sharing will count towards the plan's annual limitation on cost sharing. Oral Chemotherapy RCW 48.46.274; WAC Plan must provide coverage for prescribed, administered anticancer medication on a basis at least comparable to cancer chemotherapy medications administered by a health care provider
cl-forms-19-hmo-sg-analyst-checklist.docx