Sec. 8. 24-A MRSA §§4310 to 4313 are enacted to read:

§4310.__Access to prescription drugs

1. Formulary.__If a health plan provides coverage for prescription drugs but the coverage limits such benefits to drugs included in a formulary, a carrier shall:

A.__Ensure participation of participating physicians and pharmacists in the development of the formulary; and

B.__Provide exceptions from the formulary limitation when a nonformulary alternative is medically indicated, consistent with the utilization review standards in section 4304.

2.__Coverage of approved drugs and medical devices.__A carrier that provides coverage for prescription drugs and medical devices may not deny coverage of a prescribed drug or medical device on the basis that the use of the drug or device is investigational when the intended use of the drug or device is included in the labeling authorized by the federal Food and Drug Administration.

3.__Construction.__This section may not be construed to require a carrier to provide coverage of prescription drugs or medical devices.

§4311.__Access to specialists

1.__Definitions.__As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A.__"Specialist" means, with respect to a condition, a health care provider that has adequate expertise through appropriate training and experience to provide high-quality care in treating the condition.

B.__"Special condition" means a condition or disease that is life-threatening, degenerative or disabling and requires specialized medical care over a prolonged period of time.

2.__Obstetrical and gynecological services.__The following requirements apply to the coverage of obstetrical and gynecological services.

A.__With respect to health plans that require an enrollee to designate a primary care physician, the carrier shall allow