28 CA ADC § 1300.67.24


      28 CCR s 1300.67.24

      Cal. Admin. Code tit. 28, s 1300.67.24


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 7. STANDARDS
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.67.24. Outpatient Prescription Drug Benefits.

      (a) Every health care service plan that provides prescription drug 
      benefits shall provide coverage for all medically necessary outpatient 
      prescription drugs.

      (1) The plan may require prior authorization for coverage of the medically 
      necessary outpatient prescription drugs consistent with the provisions of 
      the Knox Keene Act, including, but not limited to Health and Safety Code 
      sections 1367.01, 1367.215 and 1367.24.

      (2) The plan may establish co-payments or deductibles for medically 
      necessary outpatient prescription drugs that are found to be 
      non-objectionable (Health and Safety Code section 1367(i)).

      (b) Nothing in this section shall be construed to prohibit plans from 
      establishing preferred drug lists or formularies consistent with the 
      provisions of the Knox Keene Act relating to prescription drug benefits, 
      including, but not limited to, Health and Safety Code sections 1363.01, 
      1367.20, 1367.21, 1367.215 and 1367.22.


      


      Note: Authority cited: Section 1344, Health and Safety Code. Reference: 
      Section 1367.24, Health and Safety Code. 


       HISTORY 
         
      1. New section filed 11-3-2000 as an emergency; operative 11-3-2000 
      (Register
      2000, No. 44). A Certificate of Compliance must be transmitted to OAL by 
3-
      5-2001 or emergency language will be repealed by operation of law on the
      following day.

      2. Certificate of Compliance as to 11-3-2000 order transmitted to OAL 
      3-5-2001
      and filed 4-16-2001 (Register 2001, No. 16).
      28 CA ADC s 1300.67.24

      END OF DOCUMENT

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