This bill amends the managed care laws related to pharmacy benefits managers, specifically focusing on the reporting and examination requirements for health plans that provide prescription drug benefits. Key changes include an increase in the notice period for formulary deletions from 45 days to 60 days, and a requirement for health plans to provide written notice in a conspicuous font of any deletions to the plan list or formulary. The bill also stipulates that if a covered person utilizes the exception process for accessing nonformulary medically necessary prescription drugs, the medication must be covered until the resolution of the exception process. Additionally, any denial of an exceptions request is classified as an adverse determination.

Furthermore, the bill mandates that health benefit plans maintain comprehensive records that must be made available to the commissioner upon request. This includes the complete drug formulary, documentation of any changes to the formulary, and the maximum allowable cost list for each pharmacy. The bill specifies that documentation must include the date and reason for any changes to both the formulary and the maximum allowable cost list. The effective date for these changes is set for January 1, 2027.

Statutes affected:
Introduced: 420-J:7-b
As Amended by the Senate: 420-J:7-b
As Amended by the House: 420-J:7-b
Version adopted by both bodies: 420-J:7-b
CHAPTERED FINAL VERSION: 420-J:7-b
SB544 text: 420-J:7-b