Section 31A-22-661 - Health benefit plan procedures related to prescription drugs(1) As used in this section, "long-term drug" means an enrollee's prescription drug where the prescription has been active for at least 180 days with the health benefit plan.(2)(a) Except as provided in Subsection (2)(b), before a health benefit plan requires an enrollee to change from a prescribed long-term drug to another drug, the health benefit plan shall:(i) at least 30 days before the day on which the health benefit plan will require the enrollee to change from the long-term drug to another drug, provide notice that the health benefit plan will require the individual to change to another drug; and(ii) provide a justification for the change upon request.(b) Subsection (2)(a) does not apply if: (i) the change requires the individual to try a generic or a biosimilar of the long-term drug; or(ii) the long-term drug is not on the health benefit plan's formulary.(3) A health benefit plan shall provide an enrollee a justification as to why an enrollee must try a certain drug before a health benefit plan will cover a different prescribed drug.(4) This section does not apply to a drug that is provided under the health benefit plan's medical benefit.Added by Chapter 262, 2024 General Session ,§ 1, eff. 5/1/2024.