The proposed bill establishes new requirements for health insurers and health maintenance organizations (HMOs) regarding the disclosure of prescription drug coverage and cost-sharing practices. It mandates that insurers notify current and prospective insureds, as well as their treating physicians, of any changes to prescription drug formularies at least 60 days prior to the effective date. This notification must be accessible on the insurer's website and sent via electronic and first-class mail, detailing the specific drugs affected and the process for submitting a notice of medical necessity. Insurers are also required to maintain records of formulary changes and submit annual reports to the Office of Insurance Regulation, which will compile and publicly share this data. Additionally, starting January 1, 2026, insurers must disclose that any amount paid by a policyholder or another person on their behalf must be applied toward the policyholder's total contribution to any cost-sharing requirement.

The bill further emphasizes transparency by requiring HMOs to maintain records of formulary changes and submit annual reports detailing these changes, including drugs removed and tier adjustments. It also mandates that any payments made for prescription drugs, including those through financial assistance programs or manufacturer copay cards, count towards the insured's total cost-sharing obligations. Insurers must disclose information about third-party payments for prescription drugs that are not applied to subscribers' out-of-pocket obligations and submit annual reports on these payments. The provisions of this act will apply to health insurance policies and contracts entered into or renewed on or after January 1, 2026, and it is set to take effect on July 1, 2025.

Statutes affected:
S 1342 Filed: 627.6699, 641.31, 409.967, 641.185