Hawaii 2022 Regular Session

Hawaii House Bill HB15 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 HOUSE OF REPRESENTATIVES H.B. NO. 15 THIRTY-FIRST LEGISLATURE, 2021 STATE OF HAWAII A BILL FOR AN ACT RELATING TO HEALTH. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
22
33 HOUSE OF REPRESENTATIVES H.B. NO. 15
44 THIRTY-FIRST LEGISLATURE, 2021
55 STATE OF HAWAII
66
77 HOUSE OF REPRESENTATIVES
88
99 H.B. NO.
1010
1111 15
1212
1313 THIRTY-FIRST LEGISLATURE, 2021
1414
1515
1616
1717 STATE OF HAWAII
1818
1919
2020
2121
2222
2323
2424
2525
2626
2727
2828
2929
3030
3131 A BILL FOR AN ACT
3232
3333
3434
3535
3636
3737 RELATING TO HEALTH.
3838
3939
4040
4141
4242
4343 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
4444
4545
4646
4747 SECTION 1. The legislature finds that the costs of specialty drugs are increasing. Health plans have created a cost-sharing mechanism known as specialty tiers, which greatly increase the potential financial burden on patients. The legislature further finds that high out-of-pocket costs for specialty drugs could preclude patients from complying with the treatment protocols prescribed by their doctors. The increased cost-sharing associated with specialty tier drugs presents a significant financial strain on very ill individuals and their families. The financial burden of specialty drugs affects patients facing serious health conditions, including hemophilia, human immunodeficiency virus (HIV), hepatitis, multiple sclerosis, lupus, some cancers, and rheumatoid arthritis, among others. The purpose of this Act is to: (1) Impose dollar limits on specialty tiers in order to protect patients from unaffordable coinsurance or copayment amounts; (2) Limit patients' coinsurance or copayment fees for specialty tier drugs to $150 per month for up to a thirty day period supply of any single specialty tier drug; and (3) Allow patients to request an exception to obtain a specialty drug that would not otherwise be available on a health plan formulary. SECTION 2. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to part I to be appropriately designated and to read as follows: "§431:10A-A Specialty tier prescription coverage. (a) All individual and group accident and health or sickness insurance policies that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty drug tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug. (b) All individual and group accident and health or sickness insurance policies that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows insureds to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the insured, would have adverse effects for the insured, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34. (c) All individual and group accident and health or sickness insurance policies that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty drug tier. (d) Nothing in this section shall be construed to require an insurance policy to: (1) Provide coverage for any additional drugs not otherwise required by law; (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options. (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician. (f) Nothing contained in any other provision of law or rule shall preclude an insurance policy subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs. (g) The commissioner may adopt rules regarding the enforcement processes for this section. (h) As used in this section, unless the context otherwise requires: "Class of drugs" means a group of medications having similar actions designed to treat a particular disease process. "Coinsurance" means a cost-sharing amount set as a percentage of the total cost of a drug. "Commissioner" means the insurance commissioner. "Copayment" means a cost-sharing amount set as a dollar value. "Non-preferred drug" means a specialty drug formulary classification for certain specialty drugs deemed non-preferred and therefore subject to limits on eligibility for coverage or to higher cost-sharing amounts than preferred specialty drugs. "Preferred drug" means a specialty drug formulary classification for certain specialty drugs deemed preferred and therefore not subject to limits on eligibility for coverage or not subject to higher cost-sharing amounts than non-preferred specialty drugs. "Specialty drug" means a prescription drug: (1) That is prescribed for a person with: (A) A complex or chronic medical condition that is a physical, behavioral, or developmental condition that may have no known cure, is progressive, or can be debilitating or fatal if left untreated or undertreated, such as multiple sclerosis, hepatitis C, or rheumatoid arthritis; or (B) A rare medical disease or condition that affects fewer than two hundred thousand persons in the United States, or fewer than one in one thousand five hundred people, such as cystic fibrosis, hemophilia, or multiple myeloma; (2) That has a total monthly prescription cost of no less than $600; (3) That is not stocked at a majority of retail pharmacies; and (4) For which at least one of the following applies: (A) The drug is an oral, injectable, or infusible drug product; (B) The drug has unique storage or shipment requirements, such as refrigeration; or (C) Patients receiving the drug require education and support beyond traditional dispensing activities. "Specialty drug formulary" means a specialty drug benefit design that distinguishes, for purposes of eligibility for coverage or for cost-sharing, between preferred drugs and non-preferred drugs. "Specialty drug tier" means a tier of cost-sharing designed for specialty drugs that exceeds the amount for non-specialty drugs and that the cost-sharing amount is based on coinsurance." SECTION 3. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to part II to be appropriately designated and to read as follows: "§431:10A-B Specialty tier prescription coverage. (a) All group or blanket disability insurance policies that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty drug tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug. (b) All group or blanket disability insurance policies that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows insureds to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the insured, would have adverse effects for the insured, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34. (c) All group or blanket disability insurance policies that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty drug tier. (d) Nothing in this section shall be construed to require an insurance policy to: (1) Provide coverage for any additional drugs not otherwise required by law; (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options. (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician. (f) Nothing contained in any other provision of law or rule shall preclude an insurance policy subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs. (g) The commissioner may adopt rules regarding the enforcement processes for this section. (h) The terms "class of drugs", "coinsurance", "commissioner", "copayment", "non-preferred drug", "preferred drug", "specialty drug", "specialty drug formulary", and "specialty drug tier" shall have the same respective meanings as in section 431:10A‑A." SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows: "§432:1- Specialty tier prescription coverage. (a) All individual and group hospital and medical service corporation contracts that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug. (b) All individual and group hospital and medical service corporation contracts that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows members to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the member, would have adverse effects for the member, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34. (c) All individual and group hospital and medical service corporation contracts that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty tier. (d) Nothing in this section shall be construed to require a contract to: (1) Provide coverage for any additional drugs not otherwise required by law; (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options. (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician. (f) Nothing contained in any other provision of law or rule shall preclude a contract subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs. (g) The commissioner may adopt rules regarding the enforcement processes for this section. (h) The terms "class of drugs", "coinsurance", "commissioner", "copayment", "non-preferred drug", "preferred drug", "specialty drug", "specialty drug formulary", and "specialty drug tier" shall have the same respective meanings as in section 431:10A‑A." SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows: "§432D- Specialty tier prescription coverage. (a) All policies, contracts, plans, or agreements issued in the State by health maintenance organizations pursuant to this chapter that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty drug tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug. (b) All policies, contracts, plans, or agreements issued in the State by health maintenance organizations pursuant to this chapter that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows insureds to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the insured, would have adverse effects for the insured, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34. (c) All policies, contracts, plans, or agreements issued in the State by health maintenance organizations pursuant to this chapter that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty drug tier. (d) Nothing in this section shall be construed to require a policy, contract, plan, or agreement to: (1) Provide coverage for any additional drugs not otherwise required by law; (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options. (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician. (f) Nothing contained in any other provision of law or rule shall preclude a policy, contract, plan, or agreement subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs. (g) The commissioner may adopt rules regarding the enforcement processes for this section. (h) The terms "class of drugs", "coinsurance", "commissioner", "copayment", "non-preferred drug", "preferred drug", "specialty drug", "specialty drug formulary", and "specialty drug tier" shall have the same respective meanings as in section 431:10A‑A." SECTION 6. In codifying the new sections added by sections 2 and 3 and referenced in sections 3, 4, and 5 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act. SECTION 7. New statutory material is underscored. SECTION 8. This Act shall take effect on July 1, 2021; provided that this Act shall apply to all health plan contracts issued or renewed in this State on or after January 1, 2022. INTRODUCED BY: _____________________________
4848
4949 SECTION 1. The legislature finds that the costs of specialty drugs are increasing. Health plans have created a cost-sharing mechanism known as specialty tiers, which greatly increase the potential financial burden on patients.
5050
5151 The legislature further finds that high out-of-pocket costs for specialty drugs could preclude patients from complying with the treatment protocols prescribed by their doctors. The increased cost-sharing associated with specialty tier drugs presents a significant financial strain on very ill individuals and their families. The financial burden of specialty drugs affects patients facing serious health conditions, including hemophilia, human immunodeficiency virus (HIV), hepatitis, multiple sclerosis, lupus, some cancers, and rheumatoid arthritis, among others.
5252
5353 The purpose of this Act is to:
5454
5555 (1) Impose dollar limits on specialty tiers in order to protect patients from unaffordable coinsurance or copayment amounts;
5656
5757 (2) Limit patients' coinsurance or copayment fees for specialty tier drugs to $150 per month for up to a thirty day period supply of any single specialty tier drug; and
5858
5959 (3) Allow patients to request an exception to obtain a specialty drug that would not otherwise be available on a health plan formulary.
6060
6161 SECTION 2. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to part I to be appropriately designated and to read as follows:
6262
6363 "§431:10A-A Specialty tier prescription coverage. (a) All individual and group accident and health or sickness insurance policies that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty drug tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug.
6464
6565 (b) All individual and group accident and health or sickness insurance policies that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows insureds to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the insured, would have adverse effects for the insured, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34.
6666
6767 (c) All individual and group accident and health or sickness insurance policies that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty drug tier.
6868
6969 (d) Nothing in this section shall be construed to require an insurance policy to:
7070
7171 (1) Provide coverage for any additional drugs not otherwise required by law;
7272
7373 (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or
7474
7575 (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options.
7676
7777 (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician.
7878
7979 (f) Nothing contained in any other provision of law or rule shall preclude an insurance policy subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs.
8080
8181 (g) The commissioner may adopt rules regarding the enforcement processes for this section.
8282
8383 (h) As used in this section, unless the context otherwise requires:
8484
8585 "Class of drugs" means a group of medications having similar actions designed to treat a particular disease process.
8686
8787 "Coinsurance" means a cost-sharing amount set as a percentage of the total cost of a drug.
8888
8989 "Commissioner" means the insurance commissioner.
9090
9191 "Copayment" means a cost-sharing amount set as a dollar value.
9292
9393 "Non-preferred drug" means a specialty drug formulary classification for certain specialty drugs deemed non-preferred and therefore subject to limits on eligibility for coverage or to higher cost-sharing amounts than preferred specialty drugs.
9494
9595 "Preferred drug" means a specialty drug formulary classification for certain specialty drugs deemed preferred and therefore not subject to limits on eligibility for coverage or not subject to higher cost-sharing amounts than non-preferred specialty drugs.
9696
9797 "Specialty drug" means a prescription drug:
9898
9999 (1) That is prescribed for a person with:
100100
101101 (A) A complex or chronic medical condition that is a physical, behavioral, or developmental condition that may have no known cure, is progressive, or can be debilitating or fatal if left untreated or undertreated, such as multiple sclerosis, hepatitis C, or rheumatoid arthritis; or
102102
103103 (B) A rare medical disease or condition that affects fewer than two hundred thousand persons in the United States, or fewer than one in one thousand five hundred people, such as cystic fibrosis, hemophilia, or multiple myeloma;
104104
105105 (2) That has a total monthly prescription cost of no less than $600;
106106
107107 (3) That is not stocked at a majority of retail pharmacies; and
108108
109109 (4) For which at least one of the following applies:
110110
111111 (A) The drug is an oral, injectable, or infusible drug product;
112112
113113 (B) The drug has unique storage or shipment requirements, such as refrigeration; or
114114
115115 (C) Patients receiving the drug require education and support beyond traditional dispensing activities.
116116
117117 "Specialty drug formulary" means a specialty drug benefit design that distinguishes, for purposes of eligibility for coverage or for cost-sharing, between preferred drugs and non-preferred drugs.
118118
119119 "Specialty drug tier" means a tier of cost-sharing designed for specialty drugs that exceeds the amount for non-specialty drugs and that the cost-sharing amount is based on coinsurance."
120120
121121 SECTION 3. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to part II to be appropriately designated and to read as follows:
122122
123123 "§431:10A-B Specialty tier prescription coverage. (a) All group or blanket disability insurance policies that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty drug tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug.
124124
125125 (b) All group or blanket disability insurance policies that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows insureds to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the insured, would have adverse effects for the insured, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34.
126126
127127 (c) All group or blanket disability insurance policies that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty drug tier.
128128
129129 (d) Nothing in this section shall be construed to require an insurance policy to:
130130
131131 (1) Provide coverage for any additional drugs not otherwise required by law;
132132
133133 (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or
134134
135135 (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options.
136136
137137 (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician.
138138
139139 (f) Nothing contained in any other provision of law or rule shall preclude an insurance policy subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs.
140140
141141 (g) The commissioner may adopt rules regarding the enforcement processes for this section.
142142
143143 (h) The terms "class of drugs", "coinsurance", "commissioner", "copayment", "non-preferred drug", "preferred drug", "specialty drug", "specialty drug formulary", and "specialty drug tier" shall have the same respective meanings as in section 431:10A‑A."
144144
145145 SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:
146146
147147 "§432:1- Specialty tier prescription coverage. (a) All individual and group hospital and medical service corporation contracts that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug.
148148
149149 (b) All individual and group hospital and medical service corporation contracts that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows members to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the member, would have adverse effects for the member, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34.
150150
151151 (c) All individual and group hospital and medical service corporation contracts that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty tier.
152152
153153 (d) Nothing in this section shall be construed to require a contract to:
154154
155155 (1) Provide coverage for any additional drugs not otherwise required by law;
156156
157157 (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or
158158
159159 (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options.
160160
161161 (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician.
162162
163163 (f) Nothing contained in any other provision of law or rule shall preclude a contract subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs.
164164
165165 (g) The commissioner may adopt rules regarding the enforcement processes for this section.
166166
167167 (h) The terms "class of drugs", "coinsurance", "commissioner", "copayment", "non-preferred drug", "preferred drug", "specialty drug", "specialty drug formulary", and "specialty drug tier" shall have the same respective meanings as in section 431:10A‑A."
168168
169169 SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
170170
171171 "§432D- Specialty tier prescription coverage. (a) All policies, contracts, plans, or agreements issued in the State by health maintenance organizations pursuant to this chapter that provide coverage for prescription drugs and use a specialty drug tier shall ensure that any required copayment or coinsurance applicable to specialty drugs on a specialty drug tier does not exceed $150 per month for each specialty drug, up to a thirty day supply of any single drug.
172172
173173 (b) All policies, contracts, plans, or agreements issued in the State by health maintenance organizations pursuant to this chapter that provide coverage for prescription drugs and use a specialty drug formulary shall implement an exceptions process that allows insureds to request an exception to the formulary. Under this type of exception, a non-formulary specialty drug may be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition would not be as effective for the insured, would have adverse effects for the insured, or both. If an insured is denied an exception, the insured may pursue an internal appeal pursuant to section 432E-5 and an external review pursuant to section 432E-34.
174174
175175 (c) All policies, contracts, plans, or agreements issued in the State by health maintenance organizations pursuant to this chapter that provide coverage for prescription drugs shall be prohibited from placing all drugs in a given class of drugs on a specialty drug tier.
176176
177177 (d) Nothing in this section shall be construed to require a policy, contract, plan, or agreement to:
178178
179179 (1) Provide coverage for any additional drugs not otherwise required by law;
180180
181181 (2) Implement specific utilization management techniques, such as prior authorization or step therapy; or
182182
183183 (3) Cease use of tiered cost-sharing structures, including those strategies used to incentivize use of preventive services, disease management, and low-cost treatment options.
184184
185185 (e) Nothing in this section shall be construed to require a pharmacist to substitute a drug without the consent of the prescribing physician.
186186
187187 (f) Nothing contained in any other provision of law or rule shall preclude a policy, contract, plan, or agreement subject to this chapter from requiring specialty drugs to be obtained through a designated pharmacy or other source of those drugs.
188188
189189 (g) The commissioner may adopt rules regarding the enforcement processes for this section.
190190
191191 (h) The terms "class of drugs", "coinsurance", "commissioner", "copayment", "non-preferred drug", "preferred drug", "specialty drug", "specialty drug formulary", and "specialty drug tier" shall have the same respective meanings as in section 431:10A‑A."
192192
193193 SECTION 6. In codifying the new sections added by sections 2 and 3 and referenced in sections 3, 4, and 5 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.
194194
195195 SECTION 7. New statutory material is underscored.
196196
197197 SECTION 8. This Act shall take effect on July 1, 2021; provided that this Act shall apply to all health plan contracts issued or renewed in this State on or after January 1, 2022.
198198
199199
200200
201201 INTRODUCED BY: _____________________________
202202
203203 INTRODUCED BY:
204204
205205 _____________________________
206206
207207
208208
209209
210210
211211 Report Title: Specialty Tier Prescription Coverage; Specialty Drugs; Health Plan Description: Imposes dollar limits on specialty tiers in order to protect patients from unaffordable coinsurance or copayment amounts. Limits patients' coinsurance or copayment fees for specialty tier drugs to $150 per month for up to a thirty-day period supply. Allow patients to request an exception to obtain a specialty drug that would not otherwise be available on a health plan formulary. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
212212
213213
214214
215215
216216
217217 Report Title:
218218
219219 Specialty Tier Prescription Coverage; Specialty Drugs; Health Plan
220220
221221
222222
223223
224224
225225 Description:
226226
227227 Imposes dollar limits on specialty tiers in order to protect patients from unaffordable coinsurance or copayment amounts. Limits patients' coinsurance or copayment fees for specialty tier drugs to $150 per month for up to a thirty-day period supply. Allow patients to request an exception to obtain a specialty drug that would not otherwise be available on a health plan formulary.
228228
229229
230230
231231
232232
233233
234234
235235 The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.