A bill for an act relating to continuity of care and nonmedical switching by health carriers, health benefit plans, and utilization review organizations, and including applicability provisions.
This legislation is set to impact existing state laws by creating stricter guidelines on how health carriers manage prescription drug coverage. Specifically, it prohibits practices such as reducing the maximum coverage of prescription drug benefits, increasing cost sharing for covered drugs, and moving necessary medications to more restrictive tiers. These measures aim to protect patients from sudden changes that could jeopardize their health and ensure that they have consistent access to the medications they need.
Senate File 86 (SF86) focuses on ensuring continuity of care and addressing the issue of nonmedical switching by health carriers, health benefit plans, and utilization review organizations. The bill stipulates that during a covered person's eligibility under a health benefit plan, a health plan carrier cannot limit or exclude coverage for a prescription drug if the individual is medically stable on the drug, as determined by a healthcare professional. It emphasizes the importance of maintaining access to previously covered medications, thereby preventing abrupt changes that could harm patients.
There are notable points of contention surrounding SF86. Proponents argue that the bill is vital for patient care continuity and safeguards against practices that could lead to negative health outcomes. However, critics may worry that these requirements could limit the flexibility of health carriers in managing their formularies and could lead to increased costs for health plans overall. Additionally, while the bill allows for certain exceptions, such as removing drugs from the formulary under specific circumstances, the implications of such changes on the broader health care landscape remain a topic of debate.