This bill amends the New Mexico Insurance Code to improve health insurance coverage for services and medications related to cholesterol disorders and coronary artery health. It mandates that health insurance policies cover coronary artery calcium screenings and cholesterol lipid panels without cost sharing for eligible individuals over the age of forty-nine, with specific exceptions. Additionally, the bill 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 legislation also introduces new definitions for terms related to coverage and specifies that these provisions do not apply to certain health plans, such as short-term and high-deductible plans, until the deductible is met.

Moreover, the bill outlines that health care plans cannot impose cost sharing on eligible subscribers over the age of forty-nine unless they have a first-degree relative with a history of myocardial infarction before age forty. It also amends the powers of the board overseeing pharmacy practices, allowing it to create protocols for assessing cardiovascular risk and prescribing lipid-lowering therapies. The effective date for these provisions is set for January 1, 2027, and they will apply to all group health insurance policies and health care plans issued or renewed in the state after that date. Overall, the bill aims to enhance access to necessary screenings and medications, thereby promoting better health outcomes for individuals at risk of cardiovascular diseases.

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
PA substitute: 59A-23-7.16, 59A-46-50.5, 59A-47-45.7, 61-11-6