An Act Limiting Changes To Prescription Drug Formularies And Lists Of Covered Drugs.
Impact
The implications of this bill are significant for patients and healthcare providers. By limiting when and how drugs can be removed or moved within cost-sharing tiers, the bill seeks to provide stability for consumers who rely on specific medications throughout the duration of a plan year. This means that patients would have better assurance regarding their medication access and financial responsibilities related to their prescriptions.
Summary
House Bill 05361 aims to regulate the ability of health carriers in the state to modify their drug formularies and lists of covered prescription drugs. Effective January 1, 2021, the bill stipulates that health carriers cannot remove a prescription drug from their formulary during a plan year unless specific conditions are met. This includes providing at least 90 days' advance notice to affected patients and their physicians in situations where the drug's safety is questioned by the FDA.
Conclusion
As this bill moves through the legislative process, it is likely to generate discussions about healthcare affordability and patient rights in the prescription drug market. Stakeholders including insurers, healthcare providers, and patient advocacy groups will be key participants in these discussions, highlighting the bill's potential to significantly reshape state health policy.
Contention
Notable points of contention surrounding HB 05361 revolve around the balance between cost-control for insurance providers and patient care continuity. Supporters argue that the bill protects patients from sudden changes that could disrupt treatment, while critics may concern themselves with how these restrictions could affect the overall flexibility and cost-management capabilities of health plans. The ability of health carriers to adjust their formularies in response to market changes or new drug approvals is also a point of debate.
An Act Prohibiting Certain Health Carriers From Requiring Step Therapy For Prescription Drugs Used To Treat A Mental Or Behavioral Health Condition Or A Chronic, Disabling Or Life-threatening Condition.
An Act Concerning Insurance Market Conduct And Insurance Licensing, The Insurance Department's Technical Corrections And Other Revisions To The Insurance Statutes And Captive Insurance.
An Act Concerning The Availability Of Telehealth Providers In Determining Network Adequacy And Extending The Telehealth Provisions Adopted During The Covid-19 Pandemic.
Relating to the regulation of prescriptions for controlled substances, including certain procedures applicable to electronic prescriptions for Schedule II controlled substances.