632.853 Coverage of drugs and devices. A health care plan, as defined in s. 628.36 (2) (a) 1., or a self-insured health plan, as defined in s. 632.85 (1) (c), that provides coverage of only certain specified prescription drugs or devices shall develop a process through which a physician may present medical evidence to obtain an individual patient exception for coverage of a prescription drug or device not routinely covered by the plan. The process shall include timelines for both urgent and nonurgent review.
History: 1997 a. 237.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 632 - Insurance contracts in specific lines.
632.07 - Prohibiting requiring property insurance in excess of replacement value.
632.10 - Definitions applicable to property insurance escrow.
632.102 - Payment of final settlement.
632.103 - Procedure for payment of withheld funds.
632.104 - Funds released to mortgagee.
632.14 - Bonds need not be under seal.
632.17 - Validity of surety bonds.
632.18 - Rustproofing warranties insurance.
632.185 - Vehicle protection product warranty insurance policy.
632.22 - Required provisions of liability insurance policies.
632.23 - Prohibited exclusions in aircraft insurance policies.
632.24 - Direct action against insurer.
632.25 - Limited effect of conditions in employer's liability policies.
632.32 - Provisions of motor vehicle insurance policies.
632.34 - Defense of noncooperation.
632.35 - Prohibited rejection, cancellation and nonrenewal.
632.36 - Accident in the course of business or employment.
632.365 - Use of emission inspection data in setting rates.
632.37 - Motor vehicle glass repair practices; restriction on specifying vendor.
632.375 - Motor vehicle repair practices; restriction on specifying vendor.
632.38 - Nonoriginal manufacturer replacement parts.
632.41 - Prohibited provisions in life insurance.
632.42 - Trustee and deposit agreements in life insurance.
632.43 - Standard nonforfeiture law for life insurance.
632.435 - Standard nonforfeiture law for individual deferred annuities.
632.44 - Required provisions in life insurance.
632.45 - Contracts providing variable benefits.
632.46 - Incontestability and misstated age.
632.47 - Assignment of life insurance rights.
632.475 - Life insurance policy loans.
632.48 - Designation of beneficiary.
632.50 - Estoppel from medical examination.
632.56 - Required group life insurance provisions.
632.57 - Conversion option in group and franchise life insurance.
632.60 - Limitation on credit life insurance.
632.62 - Participating and nonparticipating policies.
632.63 - Unclaimed life insurance and annuities.
632.64 - Certification of disability.
632.65 - Annuities exempt from regulation.
632.66 - Annuity contracts without life contingencies.
632.67 - Effect of power of attorney for health care.
632.695 - Applicability of general transfers at death provisions.
632.697 - Benefits subject to department's right to recover.
632.71 - Estoppel from medical examination, assignability and change of beneficiary.
632.715 - Reports of action against health care provider.
632.72 - Medical benefits or assistance; assignment.
632.725 - Standardization of health care billing and insurance claim forms.
632.726 - Current procedural terminology code changes.
632.729 - Prohibiting discrimination based on COVID-19.
632.73 - Right to return policy.
632.74 - Reinstatement of individual or franchise disability insurance policies.
632.745 - Coverage requirements for group and individual health benefit plans; definitions.
632.746 - Preexisting condition; portability; restrictions; and special enrollment periods.
632.747 - Guaranteed acceptance.
632.748 - Prohibiting discrimination.
632.749 - Contract termination and renewability.
632.7495 - Guaranteed renewability of individual health insurance coverage.
632.7497 - Modifications at renewal.
632.75 - Prohibited provisions for disability insurance.
632.755 - Public assistance and early intervention services.
632.76 - Incontestability for disability insurance.
632.77 - Permitted provisions for disability insurance policies.
632.775 - Effect of power of attorney for health care.
632.78 - Required grace period for disability insurance policies.
632.793 - Notice of loss of primary insurance coverage due to age.
632.795 - Open enrollment upon liquidation.
632.797 - Disclosure of group health claims experience.
632.798 - Out-of-pocket costs.
632.80 - Restrictions on medical payments insurance.
632.81 - Minimum standards for certain disability policies.
632.82 - Renewability of long-term care insurance policies.
632.825 - Midterm termination of long-term care insurance policy by insured.
632.83 - Internal grievance procedure.
632.835 - Independent review of coverage denial determinations.
632.84 - Benefit appeals under certain policies.
632.845 - Prohibiting refusal to cover services because liability policy may cover.
632.85 - Coverage without prior authorization for treatment of an emergency medical condition.
632.853 - Coverage of drugs and devices.
632.855 - Requirements if experimental treatment limited.
632.857 - Explanation required for restriction or termination of coverage.
632.861 - Prescription drug charges.
632.865 - Pharmacy benefit managers.
632.866 - Step therapy protocols.
632.867 - Oral and injected chemotherapy.
632.87 - Restrictions on health care services.
632.873 - Restrictions relating to fees for dental services.
632.875 - Independent evaluations relating to chiropractic treatment.
632.88 - Policy extension for handicapped children.
632.885 - Coverage of dependents.
632.89 - Coverage of mental disorders, alcoholism, and other diseases.
632.896 - Mandatory coverage of adopted children.
632.897 - Hospital and medical coverage for persons insured under individual and group policies.
632.8985 - Prohibiting abortion coverage.
632.899 - Medical savings accounts study.
632.93 - The fraternal contract.
632.95 - Fraud in obtaining membership.
632.96 - Beneficiaries in fraternal contracts.
632.97 - Application of proceeds of credit insurance policy.
632.975 - Portable electronics insurance.