§ 22:1060.1 Definitions
§ 22:1060.2 A health insurance issuer of a health benefit plan that covers prescription drugs and uses one or more drug formularies to specify the prescription drugs covered under the plan shall
§ 22:1060.3 A. A health insurance issuer of a health benefit plan that covers prescription drugs shall offer to each enrollee at the contracted benefit level and until the enrollee’s plan renewa
§ 22:1060.4 A. The refusal of a health insurance issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for purposes of the Internal Claims and Appeals Pro
§ 22:1060.5 Specialty drug tiers; prohibitions; limits on copayments
§ 22:1060.6 A. An individual shall not be required to make a payment for pharmacists’ services in an amount greater than the pharmacist or pharmacy providing the pharmacists’ services may retain
§ 22:1060.7 A. Notwithstanding any provision of law to the contrary, when a licensed physician prescribes a nonopioid medication for the treatment of chronic pain, it shall be unlawful for a hea
§ 22:1060.8 A. No health coverage plan delivered or issued for delivery in this state shall limit or exclude coverage involving a minor for a drug on the basis that the drug is prescribed for a

Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 4 > Part III > Subpart B-1 - Coverage of Prescription Drugs Through a Drug Formulary

  • Administrator: means a third party other than the warrantor who is designated by the warrantor to be responsible for the administration of vehicle protection product warranties. See Louisiana Revised Statutes 32:1272
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Authorized prescriber: means a person licensed, registered, or otherwise authorized by the appropriate licensing board to prescribe prescription drugs in the course of professional practice. See Louisiana Revised Statutes 22:1060.1
  • Commission: means the Louisiana Motor Vehicle Commission. See Louisiana Revised Statutes 32:1272
  • Contract: A legal written agreement that becomes binding when signed.
  • drug: means any of the following:

    (a)  A substance for which federal or state law requires a prescription before the substance may be legally dispensed to the public. See Louisiana Revised Statutes 22:1060.1

  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Executive director: means the executive director of the Louisiana Motor Vehicle Commission. See Louisiana Revised Statutes 32:1272
  • formulary: means a list of prescription drugs which meets any of the following criteria:

    (a)  For which a health benefit plan provides coverage. See Louisiana Revised Statutes 22:1060.1

  • Health care services: means services, items, supplies, or prescription drugs for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1060.1
  • Incidental costs: means expenses specified in the warranty incurred by the warranty holder related to the failure of the vehicle protection product to perform as provided in the warranty. See Louisiana Revised Statutes 32:1272
  • insured: means an individual who is enrolled or insured by a health insurance issuer under a health benefit plan. See Louisiana Revised Statutes 22:1060.1
  • issuer: means any entity that offers a health benefit plan through a policy, contract, or certificate of insurance subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1060.1
  • person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
  • Physician: means a person licensed by the Louisiana State Board of Medical Examiners. See Louisiana Revised Statutes 22:1060.1
  • plan: means an entity which provides benefits through or by a health insurance issuer consisting of health care services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as health care services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization agreement, or health maintenance organization contract; however, "health benefit plan" shall not include benefits due under Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950 or limited benefit and supplemental health insurance policies, benefits provided under a separate policy, certificate, or contract of insurance for accidents, disability income, limited scope dental or vision benefits,  benefits for long-term care, nursing home care, home health care, or specific diseases or illnesses, or any other limited benefit policy or contract as defined in La. See Louisiana Revised Statutes 22:1060.1
  • Service of process: The service of writs or summonses to the appropriate party.
  • Statute: A law passed by a legislature.
  • Vehicle protection product: means a vehicle protection device, system, or service that is:

    (i)  Installed on or applied to a vehicle. See Louisiana Revised Statutes 32:1272

  • warrantor: means a person who is contractually obligated to the warranty holder under the terms of the vehicle protection product warranty agreement. See Louisiana Revised Statutes 32:1272
  • warranty: means a written agreement by a warrantor that provides if the vehicle protection product fails to prevent loss or damage to a vehicle from a specific cause, that the warrantor will pay to or on behalf of the warranty holder specified incidental costs as a result of the failure of the vehicle protection product to perform pursuant to the terms of the warranty. See Louisiana Revised Statutes 32:1272
  • Warranty holder: means a person who purchases a vehicle protection product or who is a permitted transferee. See Louisiana Revised Statutes 32:1272
  • Warranty reimbursement insurance policy: means a policy of insurance that is issued to the vehicle protection product warrantor to provide reimbursement to the warrantor or to pay on behalf of the warrantor all covered contractual obligations incurred by the warrantor under the terms and conditions of the insured vehicle protection product warranties issued by the warrantor. See Louisiana Revised Statutes 32:1272