Provides relative to prescription drug specialty tiers. (1/1/15)
Impact
By enacting SB165, the legislation is expected to have significant implications for state laws governing health care and insurance practices in Louisiana. It provides a standardized method for health benefit plans to manage the cost of specialty drugs, thereby promoting equitable access to treatments. The introduction of an exceptions process, wherein patients can request coverage for non-formulary drugs based on clinical necessity, further empowers patients in their health care decision-making. This could enhance the healthcare experience for individuals requiring specialized medications, fostering better health outcomes.
Summary
Senate Bill 165 aims to set specific limits on co-payments and coinsurance for specialty drugs in health insurance plans. It mandates that any health insurance issuer utilizing a specialty drug tier must limit the required co-payment or coinsurance to a maximum of $150 per month for each prescription, up to a 30-day supply. This regulation is designed to alleviate the financial burden on individuals who require expensive specialty medications, ensuring that patients do not face prohibitive costs when accessing necessary treatments at the pharmacy.
Sentiment
The sentiment surrounding SB165 appears to be largely positive, particularly among legislators and constituents who advocate for improved access to essential health care. Supporters argue that the bill represents a necessary step towards protecting patients from exorbitant drug costs and ensuring that financial barriers do not prevent individuals from receiving critical health interventions. However, it is essential to note that there may be dissenting voices from some in the insurance industry who could argue about the potential financial impacts this law may impose on insurance companies managing claims and coverage.
Contention
Despite the overall positive reception of SB165, there could be points of contention regarding the implementation of the exceptions process and its potential administrative burden on health plans. Disputes may arise surrounding how exceptions are adjudicated, particularly in instances where a prescribed drug is deemed not to be as effective as formulary alternatives. Additionally, the exemption of the Office of Group Benefits raises questions about the bill's applicability across different segments of the health insurance market, potentially resulting in inconsistencies in drug pricing and access.