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 to 60 days, allowing covered persons more time to adjust to changes. Additionally, the bill specifies that the font size for written notices must be at least 14 points, up from the previous requirement of 12 points, ensuring better readability. It also introduces a provision that any denial of an exceptions request for nonformulary medically necessary prescription drugs will be considered an adverse determination.

Furthermore, the bill mandates that health benefit plans maintain comprehensive records related to their drug formularies and maximum allowable cost lists. New requirements include documentation of changes to the formulary and maximum allowable cost lists, including the dates of changes and notifications to impacted pharmacies. The effective date for these changes is set for January 1, 2027. The Office of Legislative Budget Assistant has indicated that this bill will have no fiscal impact on state, county, or local expenditures or revenue.

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
SB544 text: 420-J:7-b