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Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law requires specified services and drugs to be covered by the various plans. Existing law prohibits specified health care service plan contracts that cover prescription drug benefits from limiting or excluding coverage for a drug for an enrollee under specified conditions, including if the drug previously had been approved for coverage by the plan for a medical condition of the enrollee. Existing law specifies that these provisions do not preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee.
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