Prescription drugs; prohibiting a health insurer from modifying coverage under certain conditions; providing exception; establishing civil penalty. Effective date.
Impact
By codifying these protections into law, SB145 presents a significant shift in how insurance companies may manage their drug formularies. Currently, insurers have considerable discretion in modifying drug coverage, often leading to interruptions in patient access to necessary medications. This bill requires insurers to maintain coverage unless certain exceptions apply, such as safety concerns raised by the FDA or notifications regarding discontinuation of a drug by the manufacturer. If enacted, this measure could enhance the ability of patients to manage their healthcare effectively, potentially leading to better health outcomes.
Summary
SB145 aims to impose restrictions on health insurers regarding the modification of coverage for prescription drugs. Specifically, the bill prohibits insurers from altering coverage terms if the insured has previously been authorized for the drug, has received it, and continues to have it prescribed by a practitioner. This provision seeks to provide stability for patients reliant on specific prescription medications and protect them from sudden changes in their insurance benefits concerning those medications.
Contention
Discussions around SB145 highlight a contention between the rights of patients to access consistent healthcare versus the operational flexibility of insurance companies. Opponents of the bill may argue that these restrictions could hinder insurers from adapting to changes in drug safety or efficacy and may impact the overall costs of health insurance. On the other hand, advocates emphasize the importance of patient rights and access to necessary medications, prioritizing the continuity of care over the business interests of insurers. The enforcement of civil penalties for violations further underscores the seriousness with which this issue is being treated.
Enforcement
The bill outlines civil penalties that will be enforced by the Insurance Commissioner for any violations related to the modification of coverage. This stipulation reflects a proactive approach to ensuring compliance among insurers and providing a remedy for affected patients. As it stands, SB145 is positioned to significantly enhance regulatory scrutiny over health insurance practices related to pharmaceutical coverage.
Carry Over
Prescription drugs; prohibiting a health insurer from modifying coverage under certain conditions; providing exception; establishing civil penalty. Effective date.
Prescription drugs; prohibiting a health insurer from modifying coverage under certain conditions; providing exception; establishing civil penalty. Effective date.
Public health and safety; step therapy requirements for certain drugs for certain conditions; definitions; authorizing a health benefit plan to allow coverage for prescription drugs for advanced metastatic cancer and associated conditions without proving step therapy; effective date.
Abstracting; modifying requirements under the Oklahoma Abstractors Act; providing exception for determination of unnecessary delay; increasing certain civil penalties. Effective date.
Behavioral health; requiring health insurer to cover certain out-of-network services under certain circumstances; providing exceptions. Effective date.
Pharmaceuticals; prohibiting certain drug plans to refuse dispensing certain drugs under certain circumstances; requiring certain drugs meet certain federal requirements; prohibiting patients from payment of certain fees beyond cost-sharing obligation; establishing penalties. Effective date. Emergency.