44-7,101. Prescription drug information card or other technology; requirements; use.

(1) All insurers delivering, issuing for delivery, or renewing in this state a health benefit plan which provides coverage for prescription drugs and devices and that issues, uses, or requires a card or other technology for prescription claims submission, or the insurer's agents or contractors that issue such cards or other technology, shall issue to each insured a prescription drug information card or other technology that:

(a) Conforms to the standards and format of the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide by including all of the standard information adopted by the implementation guide and required by the health benefit plan for submission and adjudication of claims for prescription drugs or devices; or

(b) Contains at a minimum the following appropriately labeled information:

(i) The card issuer name or logo on the front of the card;

(ii) The cardholder's name and identification number on the front of the card;

(iii) Complete information for electronic transaction claims routing, including:

(A) The international identification number, labeled as RxBIN;

(B) The processor control number, labeled as RxPCN, if required for proper routing of electronic claim transactions for prescription benefits; and

(C) The group number, labeled as RxGrp, if required for proper routing of electronic claim transactions for prescription benefits;

(iv) The name and address of the health benefit plan benefits administrator or the entity responsible for prescription benefits claims submission or adjudication or pharmacy provider correspondence for prescription benefits claims; and

(v) A help desk telephone number that pharmacy providers may call for prescription benefits claims assistance.

(2) All information required by subsection (1) of this section that is necessary for submission and adjudication of claims for prescription drug or device benefits, exclusive of information that can be derived from the prescription, shall be included in a clear, readable, and understandable manner on the card or other technology issued by the insurer or its agents or contractors. The content and format of all information required by such subsection shall be in the content and format required by the health benefit plan for electronic claims routing, submission, and adjudication.

(3) A prescription drug information card or technology required under subsection (1) of this section shall be issued by an insurer upon enrollment in a health benefit plan and reissued within a reasonable time upon any change in the insured's coverage that impacts data contained on the card or technology, except that the insurer or its agents or contractors shall not be required to issue a new prescription drug information card more than once in a calendar year and nothing in this section prevents the insurer or its agents or contractors from issuing stickers or other methodologies to the insureds to update the cards or other technology temporarily until the cards or other technology are reissued or from reissuing updated new cards or other technology on a more frequent basis. Cards or technology shall be updated with the latest coverage information and shall comply with the format as approved in subsection (1) of this section.

(4) The card or other technology may be used for any and all health insurance coverage. Nothing in this section requires any person issuing, using, or requiring the card or other technology to issue, use, or require a separate card for prescription coverage if the card or other technology can accommodate the information necessary to process the claim as required by subsection (1) of this section.

(5) For purposes of this section, health benefit plan means any individual or group sickness and accident insurance policy or subscriber contract, nonprofit hospital or medical service policy or plan contract, or health maintenance organization contract and any self-funded employee benefit plan to the extent not preempted by federal law or exempted by state law. Health benefit plan does not mean one or more, or any combination, of the following:

(a) Coverage only for accident or disability income insurance, or any combination thereof;

(b) Credit-only insurance;

(c) Coverage for specified disease or illness;

(d) Limited-scope dental or vision benefits;

(e) Coverage issued as a supplement to liability insurance;

(f) Automobile medical payment insurance or homeowners medical payment insurance;

(g) Insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability policy or equivalent self-insurance coverage; or

(h) Hospital indemnity or other fixed indemnity insurance.

(6) This section shall apply to all health benefit plans delivered or issued for delivery on or after January 1, 2004, and to all health benefit plans renewed on or after January 1, 2005.

(7) The Department of Insurance shall enforce this section. The department may adopt and promulgate rules and regulations to carry out the purposes of this section.

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