Oklahoma § 63-2550.4 - Nonformulary or prior-authorized drugs - Approval

§ 63-2550.4. Nonformulary or prior-authorized drugs - Approval

A. A managed care plan that has a closed formulary or that

requires prior authorization to obtain certain drugs shall approve

or disapprove a provider’s or a covered person’s request for a

nonformulary drug or a drug that requires prior authorization within

twenty-four (24) hours of receipt of such request.

B. If the managed care plan does not render a decision within

twenty-four (24) hours, the provider or covered person shall be

entitled to a seventy-two-hour supply of the drug. The managed care

plan shall then approve or disapprove the request for a nonformulary

Oklahoma Statutes - Title 63. Public Health and Safety

drug or prior authorized drug within the additional seventy-two-hour

period.

C. Failure of the managed care plan to respond within the

subsequently allowed seventy-two-hour period shall be deemed as

approval of the request for the nonformulary drug or prior

authorized drug; provided, however, the approval shall be subject to

the terms of the managed care plan’s drug formulary; provided

further, the purchase of the approved drug shall be at no additional

cost to the covered person beyond what the covered person would

otherwise pay for a prescription pursuant to the managed care plan.

D. All providers and covered persons in a managed care plan

shall be provided with a copy of the plan’s drug prior authorization

process upon initial contracting or enrollment and at the time of

enactment of any subsequent changes to the process.

Added by Laws 1999, c. 361, § 4, eff. Nov. 1, 1999.