An Act Requiring Health Insurance Coverage Of A Prescribed Drug During Adverse Determination Reviews And External Review Processes.
Impact
If enacted, SB00025 would amend several sections of the state statutes relating to health insurance. Specifically, it mandates health carriers to issue immediate electronic authorizations for a temporary supply of prescribed drugs while a grievance or review is pending. This change aims to protect patients from disruptions in their medication regimens during the often lengthy grievance process and aligns with the broader trend towards improving patient rights and access to medications in situations of insurance disputes.
Summary
SB00025 is an act aimed at requiring health insurance coverage for prescribed drugs during the processes of adverse determination reviews and external reviews. The bill's purpose is to ensure that individuals who are contesting an adverse decision by their health insurance carrier regarding a prescribed medication are able to receive that medication throughout the review process. This ensures continuity of care at a critical time when patients may be waiting for a determination on whether their insurance will cover a certain drug.
Sentiment
The sentiment surrounding SB00025 appears to be largely positive, especially from patient advocacy groups and healthcare providers who see it as a necessary measure to protect individuals' access to essential medications. Legislative discussions indicate a shared commitment to improving patient outcomes and mitigating the impact of adverse insurance determinations. However, there could be some concerns from insurance providers regarding the potential for increased costs or administrative burdens associated with compliance.
Contention
Notable points of contention include the possibility that the bill could lead to increased operational costs for health insurance companies, especially if they are required to cover a significant number of temporary prescriptions resulting from adversarial determinations. Additionally, there may be debates on the extent to which this law would necessitate adjustments to current review processes, highlighting the balance between patient needs and the financial realities of insurance providers.
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.
An Act Concerning Dispensation And Coverage Of A Prescribed Drug For A Chronic Disease During Certain Adverse Determination Reviews, And Decreasing The Time Frames For Urgent Care Adverse Determination Review Requests.