N.M. Admin. Code § 13.10.32.12
Current through Register Vol. 35, No. 23, December 10, 2024
Section 13.10.32.12 - TRANSPARENCY OF COVERAGEA.Forms. An insurer shall provide each covered person with a contraceptive coverage summary that clearly explains the scope of contraceptive coverage and how to access this benefit at least annually. The coverage summary through written materials or links to an insurer's website and a toll free number must include the following information: (1) whether covered services or supplies are available from in-network and out-of-network providers;(2) whether there are any limitations on contraceptive services or supplies;(3) that the coverage required shall not be subject to: (a) cost sharing for insureds;(c) prior authorization or step-therapy requirements; or(d) any other restrictions or delays on the coverage;(4) if elected by the insurer, that brand-name pharmacy drugs or items are subject to cost sharing when at least one generic or therapeutic equivalent is covered within the same method of contraception without patient cost sharing, unless the insured's health care provider determines that a particular drug or item is medically necessary;(5) that coverage will be provided for a six-month supply of prescribed and self-administered contraceptives;(6) a list of the covered contraceptive drugs and devices, as well as clinical services, that are covered without cost-sharing;(7) a description of the process and forms required to address coverage disputes in Sections 59A23-12.1, 59A-47-47.1, 59A-22B-5, 59A-22-42, or 59A-46-52 NMSA 1978, as applicable, or 13.10.17 NMAC; and(8) a description of the process and forms related to coverage for contraception where a prescription is not required.B.Drug formulary requirements. An insurer shall identify on its publicly available drug formulary any cost-sharing free contraceptive drugs and devices.N.M. Admin. Code § 13.10.32.12
Adopted by New Mexico Register, Volume XXXI, Issue 21, November 10, 2020, eff. 1/1/2021