This bill amends the Health Care Purchasing Act and sections of the New Mexico Insurance Code to improve coverage for cholesterol-related health services and medications. It prohibits cost sharing for generic medications used to treat cholesterol disorders and for second-line step therapy medications if the generic options are ineffective or cause adverse reactions. The bill also expands eligibility for coronary artery calcium screenings and cholesterol lipid panels, ensuring that individuals over the age of forty-nine do not incur cost sharing unless they have a strong family history of coronary artery disease or are diagnosed with symptoms by their healthcare provider. Additionally, it introduces new definitions and clarifications regarding coverage, including the definition of "cost sharing," while specifying that these provisions do not apply to certain plans, such as catastrophic or high-deductible health plans, until the deductible is met.

Moreover, the bill establishes requirements for coverage of cholesterol-lowering medications, mandating no cost-sharing for generic medications and waiving cost-sharing for second-line therapies if generics are ineffective or cause adverse reactions. It also empowers the pharmacy board to create rules for assessing cardiovascular risk and prescribing lipid-lowering therapies. The provisions of this act will take effect for health insurance policies issued or renewed in the state starting January 1, 2027. Notably, the bill eliminates the term "heart" in favor of "coronary artery calcium screening" and clarifies coverage conditions for eligible enrollees, ensuring better access to essential health services related to cholesterol management while reducing financial barriers for patients.

Statutes affected:
introduced version: 13-7-24, 27-2-12.31, 59A-23-7.16, 59A-46-50.5, 59A-47-45.7, 61-11-6