Montana Code 33-22-154. Coverage for refill of eyedrops
33-22-154. (Effective January 1, 2024) Coverage for refill of eyedrops. (1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage of prescription eyedrops may not deny coverage for a refill of a prescription eyedrop if:
Terms Used In Montana Code 33-22-154
- Contract: A legal written agreement that becomes binding when signed.
- Medical care: means :
(a)the diagnosis, cure, mitigation, treatment, or prevention of disease or amounts paid for the purpose of affecting any structure or function of the body;
(b)transportation primarily for and essential to medical care referred to in subsection (19)(a); or
(c)insurance covering medical care referred to in subsections (19)(a) and (19)(b). See Montana Code 33-22-140
(a)the eyedrop is a covered benefit under the policy, contract, or agreement;
(b)the prescriber indicates on the original prescription that additional quantities are needed;
(c)the refill requested by the insured does not exceed the number of additional quantities needed; and
(d)(i) an amount of time has passed in which the insured should have used 70% of the dosage unit of the drug according to the prescriber’s instructions; or
(ii)(A) 21 days have passed since a 30-day supply of the eyedrop was dispensed;
(B)42 days have passed since a 60-day supply of the eyedrop was dispensed; or
(C)63 days have passed since a 90-day supply of the eyedrop was dispensed.
(2)(a) Coverage under this section may be subject to deductibles, coinsurance, and copayment provisions and to utilization review as provided in Title 33, chapter 32.
(b)Special deductible, coinsurance, copayment, or other limitations that are not generally applicable to other medical care covered under the plan may not be imposed on the coverage under this section.