P.R. Laws tit. 26, § 9046
(a) Health insurance organizations or issuers or pharmacy benefit managers shall meet the following requirements:
(1) Every health insurance organization or issuer or pharmacy benefits manager shall maintain and make available to covered persons or enrollees, prescribers and pharmacies, or those providing healthcare services to:
(A) Its formulary (list of prescription drugs) by therapeutic category and, in the case of pharmacy benefit managers, the list of prices known as “maximum allowable cost”;
(B) information indicating which prescription drugs, if any, are subject to a management procedure that has been developed and maintained pursuant to this chapter, and
(C) information on how and what written documentation is required to be submitted in order for covered persons or enrollees, or their authorized representatives, to file a request under the health insurance organization or issuer’s medical exceptions process established pursuant to § 9047 of this title
(2) A health insurance organization or issuer shall only make, during the term of the policy, certificate, or contract, changes in the formulary, or other prescription drugs management process if such change is being made for safety reasons or because the prescription drug cannot be supplied or has been withdrawn from the market by the drug’s manufacturer, or if such change entails the inclusion of prescription drugs in the formulary. To such effects, not later than the effective date of the change, the health insurance organization or issuer shall provide notice of, or shall entrust a third party to provide notice of that change to:
(A) All covered persons or enrollees, and
(B) participating pharmacies only if such change entails the inclusion of prescription drugs in the formulary. In such case, the issuer shall provide notice thereof thirty (30) days before the effective date of inclusion.
History —Aug. 29, 2011, No. 194, § 4.060, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 3, eff. 30 days after July 10, 2013.