P.R. Laws tit. 26, § 9048
(a) Each health insurance organization or issuer shall maintain sufficient written or electronic records to demonstrate compliance with this chapter, including records documenting the process for making decisions on formularies and other prescription drug management processes and records documenting the application of the medical exception request process. The records shall be maintained for a period of three (3) years or until the completion of the health insurance organization or issuer's next market conduct examination, whichever is later, and shall be made available to the Commissioner upon request.
(b) Each health insurance organization or issuer shall maintain data on and make available to the Commissioner upon request the following information with respect to medical exception requests:
(1) The total number of medical exception requests;
(2) from the total number of medical exception requests provided under clause (1):
(A) The number of requests made for coverage of a nonformulary prescription drug;
(B) the number of requests made for continuing coverage of a prescription drug that the health insurance organization or issuer was discontinuing from coverage on the formulary for reasons other than safety or because the drug cannot be supplied or has been withdrawn from the market by the drug's manufacturer, and
(C) the number of requests made for an exception to a management process that subjects a prescription drug to dose restrictions or step therapy requirements;
(3) the number of medical exceptions requests approved and denied, and
(4) any other information that the Commissioner may request.
History —Aug. 29, 2011, No. 194, § 4.080, eff. 180 days after Aug. 29, 2011.