Provides relative to notice and appeal of a change in coverage of medically necessary prescription drugs and intravenous infusions
The enactment of HB 1151 introduces significant changes to the relationship between patients and their health insurance providers. By requiring advance notice and allowing for appeals, the bill equips patients with greater power to contest decisions that affect their health care. This aligns with efforts to protect consumer rights and ensures transparency in health insurance practices. The bill is applicable to health benefit plans issued or renewed after January 1, 2017, thereby impacting a substantial segment of the population reliant on health insurance for prescription coverage.
House Bill 1151 addresses the procedures surrounding changes in health insurance coverage, specifically concerning medically necessary prescription drugs and intravenous infusions. The bill mandates that health insurance issuers must provide at least 60 days notice to insured individuals if there is a proposed change in coverage that may affect them. This notice requirement is waived if the drug has been covered for less than 60 days. The bill also establishes the right for insured individuals to appeal such proposed changes, ensuring they can contest alterations in coverage during the notification period if their physician deems continued usage medically necessary.
The sentiment surrounding HB 1151 is generally positive, with strong support from consumer advocacy groups who appreciate the increased patient protections against abrupt changes in medication coverage. Legislators recognized the importance of maintaining treatment consistency for patients requiring ongoing medications. The bill’s support was evident during discussions and the voting process, where it received bipartisan approval with no opposing votes documented in the House vote held on June 2, 2016.
Despite its broad support, there may have been some contention regarding the logistics of implementing the notice and appeals processes. Critics could argue that imposing such requirements may lead to increased administrative burdens on health insurance providers and potential delays in policy updates. Additionally, while the bill serves to protect patients, there may be concerns about the implications for insurers in terms of costs and the management of their formularies. These points underscore the ongoing tension between patient rights and the regulatory framework governing health insurance.