Tex. Ins. Code § 1369.056

Current with legislation from the 2023 Regular and Special Sessions signed by the Governor as of November 21, 2023.

Section 1369.056 - Adverse Determination

(a) The refusal of a health benefit plan issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for purposes of Section 4201.002 if:

(1) the drug is not included in a drug formulary used by the health benefit plan; and

(2) the enrollee's physician has determined that the drug is medically necessary.

(b) The enrollee may appeal the adverse determination under Subchapters H and I, Chapter 4201.

Tex. Ins. Code § 1369.056

Amended By Acts 2011, 82nd Leg., R.S., Ch. 501, Sec. 7, eff. 9/1/2011.

Amended By Acts 2007, 80th Leg., R.S., Ch. 730, Sec. 2G.012, eff. 4/1/2009.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. 4/1/2005.