Section 1367.42 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.42
. (a) For plan years commencing on or after January 1, 2017,
a plan that provides essential health benefits shall allow an
enrollee to access prescription drug benefits at an in-network retail
pharmacy unless the prescription drug is subject to restricted
distribution by the United States Food and Drug Administration or
requires special handling, provider coordination, or patient
education that cannot be provided by a retail pharmacy.
(b) A nongrandfathered individual or small group health plan
contract may charge an enrollee a different cost sharing for
obtaining a covered drug at a retail pharmacy, but all cost sharing
shall count toward the plan's annual limitation on cost sharing
consistent with Section 1367.006.