70.976 Restrictive Formulary Drug Prescription Sanction Through Managed Care:
MSSNY will develop and propose legislation or regulation requiring (a) pharmacists to contact the prescribing physician if a prescription written by the physician violates the managed care formulary under which the patient is covered, so that the physician has an opportunity to prescribe an alternative drug, which may be on the formulary; (b) which prohibits managed care entities, and other insurers, from disciplining, or withholding payment from physicians because they have prescribed drugs to patients which are not on the insurer’s formulary or have appealed a plan’s denial of coverage for the prescribed drug; (c) which ensures that all pharmacy benefit management companies and insurers which use restrictive drug formularies be required to impanel an independent group of physicians to determine the composition of the drug formulary; (d) will request the American Medical Association to examine the feasibility of establishing a standardized process for formulary development applicable to all managed care plans. (HOD 1998-55; Reaffirmed HOD 2001-53; Reaffirmed HOD 2011; Reaffirmed HOD 2021)
