N.M. Admin. Code § 13.10.32.8

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.32.8 - COVERAGE REQUIREMENTS

A.Oral contraceptives. An insurer satisfies its obligation to cover a sufficient number and assortment of oral contraceptives to reflect the variety of oral contraceptives approved by the federal food and drug administration only if its plan covers contraceptive pills of differing hormone combinations at differing strengths that reflect the variety of unique combinations approved by the federal food and drug administration.

B.Immediate Post-Partum Long Acting Reversible Contraception. Included in the description of clinical services covered by this rule is immediate (pre-discharge) post-partum long acting reversible contraception.

C.Six-Month Dispensing. An insurer shall provide coverage and shall reimburse a health care provider or dispensing entity on a per unit basis for dispensing a six-month supply of contraceptives, provided that the contraceptives are prescribed and self-administered. Nothing in this rule shall be construed to require a health care provider to prescribe six months of contraceptives at one time or permit an insurer to limit coverage or impose cost sharing for an alternate method of contraception if an insured changes contraceptive methods before exhausting a previously dispensed supply.

D.Coverage for Prescription Contraceptive Drugs and Devices. An insured, an insured 's designee, or an insured's health care provider may submit a request to an insurer for coverage of a non­covered contraceptive drug or device pursuant to Subsections C and D of Section 59A-22-42 NMSA 1978. Such request shall indicate whether the covered contraceptive drug or device is not available or is medically necessary for the insured. An insurer may require that the request for coverage be in writing. If the insured' s health care provider determines that the use of a non-covered drug or device is medically necessary, the health care provider's determination shall be final.

E.Sexually transmitted infections. An insurer is obligated to provide contraceptives for the prevention of sexually transmitted infections.

F.Confidentiality of services. An insurer shall maintain confidentiality of claims and services pursuant to state and federal law, including the Domestic Abuse Insurance Protection Act, Sections 59A-16B-1 et seq. NMSA 1978.

N.M. Admin. Code § 13.10.32.8

Adopted by New Mexico Register, Volume XXXI, Issue 21, November 10, 2020, eff. 1/1/2021