KRS 304.17A-611: Prohibition against retrospective denial of coverage for health care

services under certain circumstances -- Prohibition against prospective or

concurrent review of prescription drug for alcohol or opioid use disorder.

(Effective until January 1, 2028)

(1) A utilization review decision shall not retrospectively deny coverage for health care

services provided to a covered person when prior approval has been obtained from

the insurer or its designee for those services, unless the approval was based upon

fraudulent, materially inaccurate, or misrepresented information submitted by the

covered person, authorized person, or the provider.

(2) An insurer of a health benefit plan shall not require or conduct a prospective or

concurrent review for a prescription drug:

(a) That:

1. Is used in the treatment of alcohol or opioid use disorder; and

2. Contains Methadone, Buprenorphine, an opioid antagonist, or

Naltrexone; or

(b) That was approved before January 1, 2022, by the United States Foo d and

Drug Administration for the mitigation of opioid withdrawal symptoms.

Effective: January 1, 2025