The proposed bill establishes new requirements for health insurers and health maintenance organizations (HMOs) regarding the management and disclosure of prescription drug coverage. 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. Insurers must provide specific details about the affected drugs and inform that a notice of medical necessity from the treating physician can ensure continued coverage. Additionally, the bill requires insurers to maintain records of formulary changes and submit annual reports to the Office of Insurance Regulation, detailing these changes and their impact on insured individuals.

Moreover, the bill introduces provisions related to cost-sharing requirements, stipulating that any amount paid by a policyholder or another person on their behalf will count towards the policyholder's total contribution to any cost-sharing requirement. It mandates that contracts between health insurers and pharmacy benefit managers include stipulations for applying payments made for prescription drugs towards cost-sharing obligations. The bill also requires HMOs to maintain records of third-party payments for prescription drugs and submit annual reports detailing these payments. Overall, the legislation aims to enhance transparency and protect insured individuals from unexpected changes in their prescription drug coverage, with provisions set to take effect on July 1, 2025, for policies entered into or renewed on or after January 1, 2026.

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