(1) When a healthcare insurer uses a formulary for prescription drugs, the insurer shall include a written procedure whereby covered persons can obtain, without penalty and in a timely fashion, specific drugs and medications not included in the formulary when:(1) The formulary's equivalent has been ineffective in the treatment of the covered person's disease or condition; or(2) The formulary's drug causes or is reasonably expected to cause adverse or harmful reactions in the covered person.
(1) The formulary's equivalent has been ineffective in the treatment of the covered person's disease or condition; or
(2) The formulary's drug causes or is reasonably expected to cause adverse or harmful reactions in the covered person.