(1) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(2) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Nonpreferred prescription drug." A prescription drug deemed
nonpreferred by the health benefit plan and subject to higher
cost sharing than preferred prescription drugs.
"Preferred prescription drug." A prescription drug deemed
preferred by the health benefit plan and subject to lower cost
sharing than nonpreferred prescription drugs.
"Specialty tier prescription drug." A prescription drug for
which a health benefit plan imposes cost sharing in excess of
preferred prescription drugs and nonpreferred prescription
drugs.
"Tiered formulary." A formulary that provides prescription
drug coverage, as part of a health benefit plan, for which cost
sharing is determined by the category or tier of the
prescription drug.
Section 3. Specialty tier prescription drug requirements.
(a) Maximum limitations.--A health benefit plan that
provides coverage for prescription drugs shall ensure that any
required copayment or coinsurance applicable to a specialty tier
prescription drug does not exceed $100 per month for a 30-day
supply of the specialty tier drug. The aggregate cost of all
specialty tier prescription drugs required by an insured may not
exceed $200 per month.
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