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§ 20-1057.10 Eosinophilic gastrointestinal disorder; formula

AZ Rev Stat § 20-1057.10 (2019) (N/A)
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20-1057.10. Eosinophilic gastrointestinal disorder; formula

A. Any contract or evidence of coverage that is offered by a health care services organization and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if:

1. The enrollee has been diagnosed with an eosinophilic gastrointestinal disorder.

2. The enrollee is under the continuous supervision of a physician who is licensed pursuant to title 32, chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15.

3. There is risk of a mental or physical impairment without the use of the formula.

B. A health care services organization shall cover at least seventy-five per cent of the cost of the formula. The health care services organization may limit the maximum annual benefit for formula under this section to twenty thousand dollars.

C. This section does not apply to limited benefit coverage as defined in section 20-1137.

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