Section 2030.50  Filing Requirement

a)         By October 1, 2025, a health insurance issuer that maintains drug formularies must submit all drug formularies for health products in which it has enrolled a covered individual for review for compliance with this Part. The filing must be submitted to the Department through the Systems for Electronic Rates & Forms Filing (SERFF).

b)         For health products subject to Section 87(f) of the Managed Care Reform and Patient Rights Act, by October 1, 2025, a health insurance issuer also must file all drug formularies that the issuer intends to use for all health products for which the issuer has filed its policy forms with the Department that will have a plan year or policy year beginning in 2026, even if the health product has no enrolled covered individuals on the filing date. Nothing in this subsection prevents the issuer from removing or adding a drug to the formulary after the Department has completed its review and before the beginning of the plan year or policy year.

c)         If a health insurance issuer has not filed a policy form with the Department for any health product that uses a drug formulary by October 1, 2025, and if the issuer later files a policy form for a health product that uses a drug formulary, the issuer must submit all drug formularies for all health products to the Department for review for compliance with this Part by the first day of the first plan year, policy year, or other policy period in which at least one of the issuer's health product has enrolled a covered individual.

d)         Following the Department's review, a health insurance issuer must correct and must not implement any provisions in its drug formularies that the Department has determined are inconsistent with this Part or other applicable law.

e)         Nothing in this Part relieves a health insurance issuer that offers a plan through a Federally-facilitated Exchange, a State-based Exchange on the Federal Platform, or a State-based Exchange from any requirement to provide formulary information or data to the Exchange in the manner prescribed by the Exchange.