An Act Requiring Health Insurance Coverage Of A Prescribed Drug For A Chronic Disease During Certain Adverse Determination Reviews.
Impact
If enacted, this bill would significantly amend existing health insurance regulations by requiring carriers to notify covered persons of determination results promptly and to continue prescribed treatments during the review phase. It sets specific timeframes for health carriers to make determinations—15 days for prospective or concurrent requests and 30 days for retrospective requests. These changes would facilitate better health outcomes for patients by reducing delays in accessing medications necessary for managing chronic conditions.
Summary
SB00019, an Act Requiring Health Insurance Coverage Of A Prescribed Drug For A Chronic Disease During Certain Adverse Determination Reviews, aims to enhance patient rights by ensuring that individuals suffering from chronic diseases continue to receive necessary medications during the review period for insurance claims. This bill mandates that health insurance carriers provide temporary authorization for patients to access prescribed medications while waiting for the outcome of their coverage determinations. The goal is to prevent treatment interruptions that could negatively impact health outcomes.
Sentiment
The sentiment surrounding SB00019 has largely been supportive from patient advocacy groups, healthcare providers, and lawmakers who believe in the necessity of uninterrupted access to medications. Proponents argue that ensuring timely access to drugs for chronic diseases is critical to maintaining the health and stability of patients, while also aligning with broader health equity goals. However, some insurance industry representatives might express concern over additional mandates leading to increased operational costs.
Contention
Despite the considerable support for SB00019, there are notable points of contention regarding the implications for insurers and the administrative burden implications. Insurers may argue that the bill could complicate their processes and lead to higher premiums for consumers. Additionally, concerns about balancing oversight and ensuring that medical necessity criteria are met may arise. Therefore, the debate around this bill reflects the ongoing challenges in healthcare legislation around patient access versus regulatory burdens.
An Act Prohibiting Certain Health Carriers From Requiring Step Therapy For Prescription Drugs Used To Treat A Mental Or Behavioral Health Condition Or A Chronic, Disabling Or Life-threatening Condition.
An Act Concerning Insurance Market Conduct And Insurance Licensing, The Insurance Department's Technical Corrections And Other Revisions To The Insurance Statutes And Captive Insurance.