Health Insurance - Utilization Review for Coverage of Prescription Drugs and Devices - Expedited Appeals
Impact
The implementation of SB688 will significantly impact health insurance policies issued or renewed in Maryland starting from January 1, 2023. By streamlining the appeal process for denied coverage, it aims to protect patient access to necessary medications and devices. The expedited appeals process requires insurers to respond to appeals within 48 hours and automatically overturns a denial if the timeline is not met. The bill aims to reduce barriers for patients who may require prompt access to their prescribed treatments, thus potentially improving health outcomes.
Summary
Senate Bill 688, titled 'Health Insurance – Utilization Review for Coverage of Prescription Drugs and Devices – Expedited Appeals,' aims to set requirements for health insurers regarding the processes that govern the utilization review of prescription drug and medical device coverages. The bill mandates that denials of coverage from insurers must be decided by a physician of the same specialty as the prescriber or one specialized in the treatment of the condition in question. This approach seeks to ensure that the reviews are clinically appropriate and that the decisions about the necessity of drug coverage are grounded in relevant medical expertise.
Contention
While the bill is oriented toward improving access to healthcare, discussions surrounding SB688 underscore tension between ensuring patient care and managing insurance costs. Supporters argue that the expedited appeals process will help avert delays in treatment that may lead to exacerbation of health issues for patients. Conversely, there are concerns from some stakeholders about the potential for increased insurance costs due to the expanded obligations placed on insurers, which could impact the overall insurance market dynamics and possibly lead to higher premiums for consumers.
Relating to the regulation of prescriptions for controlled substances, including certain procedures applicable to electronic prescriptions for Schedule II controlled substances.