Mississippi 2025 Regular Session

Mississippi Senate Bill SB2045 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	MISSISSIPPI LEGISLATURE 2025 Regular Session To: Insurance By: Senator(s) Blackmon Senate Bill 2045 AN ACT TO PROHIBIT HEALTH BENEFIT PLANS, PHARMACY BENEFIT MANAGERS, MEDICAID AND PRIVATE REVIEW AGENTS FROM DENIAL OF COVERAGE OR IMPOSING RESTRICTIONS ON PRIOR AUTHORIZATION FOR DRUGS PRESCRIBED FOR THE TREATMENT OR PREVENTION OF HIV OR AIDS; AND FOR RELATED PURPOSES. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: SECTION 1. (1) As used in this section, the following terms shall be defined as provided in this subsection: (a) "Health benefit plan" means services consisting of medical care, provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer. The term "health benefit plan" includes the Medicaid fee-for-service program and any managed care program, coordinated care program, coordinated care organization program, health maintenance organization program or such other programs implemented by the Division of Medicaid under Section 43-13-117(H). (b) "Pharmacy benefit manager" has the meaning as defined in Section 73-21-179. (c) "Private review agent" has the meaning as defined in Section 41-83-1. (2) (a) Prohibition on denial of coverage. A health insurance issuer, pharmacy benefit manager, or their agent shall not refuse to authorize coverage for or approve access to any antiretroviral (ARV) drugs with a United States Food and Drug Administration label indicating the ARV is for the treatment and prevention of HIV or AIDS on the basis that such a drug is not medically necessary. (b) Exception for therapeutic equivalents. If the United States Food and Drug Administration (FDA) approves one or more therapeutically equivalent drugs, devices, or products for the treatment of HIV or AIDS, a health insurance issuer, pharmacy benefit manager, or their agent is not required to cover all therapeutically equivalent versions without prior authorization or step therapy. However, the health care plan or health insurance issuer must cover at least one (1) therapeutically equivalent version, per route of administration, without prior authorization or step therapy. SECTION 2. This act shall take effect and be in force from and after July 1, 2025.
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3	3	MISSISSIPPI LEGISLATURE
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5	5	2025 Regular Session
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7	7	To: Insurance
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9	9	By: Senator(s) Blackmon
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11	11	# Senate Bill 2045
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13	13	AN ACT TO PROHIBIT HEALTH BENEFIT PLANS, PHARMACY BENEFIT MANAGERS, MEDICAID AND PRIVATE REVIEW AGENTS FROM DENIAL OF COVERAGE OR IMPOSING RESTRICTIONS ON PRIOR AUTHORIZATION FOR DRUGS PRESCRIBED FOR THE TREATMENT OR PREVENTION OF HIV OR AIDS; AND FOR RELATED PURPOSES.
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15	15	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
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17	17	SECTION 1. (1) As used in this section, the following terms shall be defined as provided in this subsection:
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19	19	(a) "Health benefit plan" means services consisting of medical care, provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer. The term "health benefit plan" includes the Medicaid fee-for-service program and any managed care program, coordinated care program, coordinated care organization program, health maintenance organization program or such other programs implemented by the Division of Medicaid under Section 43-13-117(H).
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21	21	(b) "Pharmacy benefit manager" has the meaning as defined in Section 73-21-179.
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23	23	(c) "Private review agent" has the meaning as defined in Section 41-83-1.
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25	25	(2) (a) Prohibition on denial of coverage. A health insurance issuer, pharmacy benefit manager, or their agent shall not refuse to authorize coverage for or approve access to any antiretroviral (ARV) drugs with a United States Food and Drug Administration label indicating the ARV is for the treatment and prevention of HIV or AIDS on the basis that such a drug is not medically necessary.
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27	27	(b) Exception for therapeutic equivalents. If the United States Food and Drug Administration (FDA) approves one or more therapeutically equivalent drugs, devices, or products for the treatment of HIV or AIDS, a health insurance issuer, pharmacy benefit manager, or their agent is not required to cover all therapeutically equivalent versions without prior authorization or step therapy. However, the health care plan or health insurance issuer must cover at least one (1) therapeutically equivalent version, per route of administration, without prior authorization or step therapy.
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29	29	SECTION 2. This act shall take effect and be in force from and after July 1, 2025.