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§ 20-826.03 Eosinophilic gastrointestinal disorder; formula

AZ Rev Stat § 20-826.03 (2019) (N/A)
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20-826.03. Eosinophilic gastrointestinal disorder; formula

A. Any contract that is offered by a hospital service corporation or medical service corporation 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 subscriber has been diagnosed with an eosinophilic gastrointestinal disorder.

2. The subscriber 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 hospital service corporation or medical service corporation shall cover at least seventy-five per cent of the cost of the formula. The hospital service corporation or medical service corporation 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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