DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 1151 Original 2016 Regular Session Robert Johnson
Abstract: Provides relative to notice and appeal of a change in coverage of medically necessary
prescription drugs and intravenous infusions.
Proposed law requires that a health insurance issuer proposing to change its coverage of a particular
prescription drug or intravenous infusion based on medical necessity give notice of the proposed
change to an insured currently using that prescription drug who the health insurance issuer
determines the change may affect; however, specifies that such notice shall not be required if the
health insurance issuer has covered the drug or intravenous infusion for the insured for less than 60
days. Requires that any such notice shall be sent at least 60 days prior to the effective date of the
proposed change.
Proposed law further provides that any insured receiving such a notice from a health insurance issuer
shall have the right to appeal the proposed change during the 60-day notification period in
accordance with present law, the state's appeals law, the Internal Claims and Appeals Process and
External Review Act. Also requires that, in filing such an appeal, the insured shall document that
his physician or authorized prescriber considers continued use of the drug or intravenous infusion
to be medically necessary.
Proposed law makes certain technical changes, in particular to references and citations to present
law, the state's appeals law, the Internal Claims and Appeals Process and External Review Act.
Proposed law provides that it shall apply only to a health benefit plan delivered, issued for delivery,
or renewed on or after January 1, 2017, and shall not apply to a health benefit plan delivered, issued
for delivery, or renewed before January 1, 2017.
Effective January 1, 2017.
(Amends R.S. 22:1060.4(A)(intro. para.) and (B); Adds R.S. 22:1060.3(C))