§ 27-20.8-2 - Pharmacy benefit, limits and co-payments. - Rhode-island Statutes

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Statutes > Rhode-island > Title-27 > Chapter-27-20-8 > 27-20-8-2

SECTION 27-20.8-2

§ 27-20.8-2 Pharmacy benefit, limits andco-payments. – Any health plan that offers pharmacy benefits shall comply with the following:

(a) When a health plan's pharmacy benefit has a dollar limit,the insured's use of such benefit shall be determined based on the healthplan's contracted rate to purchase the drug minus the enrollee's applicableco-payment for covered drugs. The balance will apply towards the enrollee'sdollars limit.

(b) When a health plan charges a co-payment for coveredprescription drugs that is based on a percent of the drug cost, the health planshall disclose within the group policy or individual policy benefitsdescription statement whether the co-payment is based on the plan's contractedrate to purchase the drug or some other cost basis such as retail price.

State Codes and Statutes

Statutes > Rhode-island > Title-27 > Chapter-27-20-8 > 27-20-8-2

SECTION 27-20.8-2

§ 27-20.8-2 Pharmacy benefit, limits andco-payments. – Any health plan that offers pharmacy benefits shall comply with the following:

(a) When a health plan's pharmacy benefit has a dollar limit,the insured's use of such benefit shall be determined based on the healthplan's contracted rate to purchase the drug minus the enrollee's applicableco-payment for covered drugs. The balance will apply towards the enrollee'sdollars limit.

(b) When a health plan charges a co-payment for coveredprescription drugs that is based on a percent of the drug cost, the health planshall disclose within the group policy or individual policy benefitsdescription statement whether the co-payment is based on the plan's contractedrate to purchase the drug or some other cost basis such as retail price.

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Statutes > Rhode-island > Title-27 > Chapter-27-20-8 > 27-20-8-2

SECTION 27-20.8-2

§ 27-20.8-2 Pharmacy benefit, limits andco-payments. – Any health plan that offers pharmacy benefits shall comply with the following:

(a) When a health plan's pharmacy benefit has a dollar limit,the insured's use of such benefit shall be determined based on the healthplan's contracted rate to purchase the drug minus the enrollee's applicableco-payment for covered drugs. The balance will apply towards the enrollee'sdollars limit.

(b) When a health plan charges a co-payment for coveredprescription drugs that is based on a percent of the drug cost, the health planshall disclose within the group policy or individual policy benefitsdescription statement whether the co-payment is based on the plan's contractedrate to purchase the drug or some other cost basis such as retail price.