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Rhode Island House Bill H5350

Rhode Island 2023 Regular Session

Rhode Island House Bill H5350 Compare Versions

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99 S TATE OF RHODE IS LAND
1010 IN GENERAL ASSEMBLY
1111 JANUARY SESSION, A.D. 2023
1212 ____________
1313
1414 A N A C T
1515 RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
1616 Introduced By: Representatives Morales, Chippendale, Kislak, McNamara, Place,
1717 Kazarian, Spears, Donovan, Potter, and Newberry
1818 Date Introduced: February 03, 2023
1919 Referred To: House Health & Human Services
2020
2121
2222 It is enacted by the General Assembly as follows:
2323 SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
2424 Policies" is hereby amended by adding thereto the following section: 2
2525 27-18-50.2. Specialty drugs. 3
2626 (a) The general assembly makes the following findings: 4
2727 (1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents 5
2828 had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) 6
2929 residents had two (2) or more chronic diseases, which significantly increases their likelihood to 7
3030 depend on prescription specialty drugs; 8
3131 (2) In 2016, twenty-five percent (25%) of Rhode Island residents stopped taking a 9
3232 prescription drug as prescribed due to cost; 10
3333 (3) Most specialty drugs do not have biosimilars, generic equivalents, or substitutes to 11
3434 create competition and help lower their prices; and 12
3535 (4) In 2022, the Centers for Medicare and Medicaid Services define any drug for which the 13
3636 negotiated price is six hundred seventy dollars ($670) per month or more, as a specialty drug. 14
3737 (b) As used in this section, the following words shall have the following meanings: 15
3838 (1) "Complex or chronic medical condition" means a physical, behavioral, or 16
3939 developmental condition that is persistent or otherwise long-lasting in its effects or a disease that 17
4040 advances over time, and: 18
4141 (i) May have no known cure; 19
4242
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4545 (ii) Is progressive; or 1
4646 (iii) Can be debilitating or fatal if left untreated or undertreated. 2
4747 "Complex or chronic medical condition" includes, but is not limited to, multiple sclerosis, 3
4848 hepatitis c, and rheumatoid arthritis. 4
4949 (2) "Pre-service authorization" means a cost containment method that an insurer, a 5
5050 nonprofit health service plan, or a health maintenance organization uses to review and preauthorize 6
5151 coverage for drugs prescribed by a health care provider for a covered individual to control 7
5252 utilization, quality, and claims. 8
5353 (3) "Rare medical condition" means a disease or condition that affects fewer than: 9
5454 (i) Two hundred thousand (200,000) individuals in the United States; or 10
5555 (ii) Approximately one in one thousand five hundred (1,500) individuals worldwide. 11
5656 "Rare medical condition" includes, but is not limited to, cystic fibrosis, hemophilia, and 12
5757 multiple myeloma. 13
58-(4) "Specialty drug" means a prescription drug that exceeds the threshold for a specialty 14
59-drug under the Medicare Part D program (Medicare Prescription Drug Improvement and 15
60-Modernization Act of 2003 (Public Law 108-173)). 16
61-(5) "Specialty drug tier" means a formulary tier in the pharmacy benefit that imposes a 17
62-cost-sharing obligation for a specialty drug. 18
58+(4) "Specialty drug" means a prescription drug that: 14
59+(i) Is prescribed for an individual with a complex or chronic medical condition or a rare 15
60+medical condition; and 16
61+(ii) Has a wholesale acquisition cost or negotiated price that exceeds the Medicare Part D 17
62+specialty tier threshold, as updated from time to time. 18
6363 (c) Every individual or group health insurance contract, plan or policy that provides 19
64-prescription drug coverage and is delivered, issued for delivery or renewed in this state on or after 20
65-January 1, 2025, shall limit any required copayment of coinsurance applicable to covered drugs on 21
66-a specialty drug tier to an amount not to exceed one hundred fifty dollars ($150) per month for each 22
67-drug up to a thirty-day (30) supply of any single drug. This limit shall be inclusive of any copayment 23
68-or coinsurance. This limit shall be applicable after any deductible is reached and until the 24
69-individual's maximum out-of-pocket limit has been reached. 25
70-(d) Nothing in this section shall prevent an entity subject to this section from reducing a 26
71-covered individual's cost sharing for a specialty drug to an amount less than that described in section 27
72-(c) of this section. 28
64+prescription coverage and is delivered, issued for delivery or renewed in this state on or after 20
65+January 1, 2024, shall not impose a copayment or coinsurance requirement on a covered specialty 21
66+drug that exceeds one hundred fifty dollars ($150) for up to a thirty (30)-day supply of the specialty 22
67+drug. A pre-service authorization may be used to provide coverage for specialty drugs. Coverage 23
68+for prescription specialty drugs shall not be subject to any deductible, unless prohibiting a 24
69+deductible requirement would cause a health plan to not qualify as a high deductible health plan. 25
70+(d) Nothing in this section prevents an insurer, health maintenance plan, or nonprofit 26
71+medical plan from reducing a covered individual's cost sharing to an amount less than one hundred 27
72+fifty dollars ($150) for a thirty (30)-day supply of a specialty drug. 28
7373 (e) The health insurance commissioner may promulgate any rules and regulations 29
7474 necessary to implement and administer this section in accordance with any federal requirements 30
7575 and shall use the commissioner's enforcement powers to obtain compliance with the provisions of 31
7676 this section. 32
7777 SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 33
7878 Corporations" is hereby amended by adding thereto the following section: 34
7979
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8282 27-19-42.1. Specialty drugs. 1
8383 (a) The general assembly makes the following findings: 2
8484 (1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents 3
8585 had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) 4
8686 residents had two (2) or more chronic diseases, which significantly increases their likelihood to 5
8787 depend on prescription specialty drugs; 6
8888 (2) In 2016, twenty-five percent (25%) of Rhode Island residents stopped taking a 7
8989 prescription drug as prescribed due to cost; 8
9090 (3) Most specialty drugs do not have biosimilars, generic equivalents, or substitutes to 9
9191 create competition and help lower their prices; and 10
9292 (4) In 2022, the Centers for Medicare and Medicaid Services define any drug for which the 11
9393 negotiated price is six hundred seventy dollars ($670) per month or more, as a specialty drug. 12
9494 (b) As used in this section, the following words shall have the following meanings: 13
9595 (1) "Complex or chronic medical condition" means a physical, behavioral, or 14
9696 developmental condition that is persistent or otherwise long-lasting in its effects or a disease that 15
9797 advances over time, and: 16
9898 (i) May have no known cure; 17
9999 (ii) Is progressive; or 18
100100 (iii) Can be debilitating or fatal if left untreated or undertreated. 19
101101 "Complex or chronic medical condition" includes, but is not limited to, multiple sclerosis, 20
102102 hepatitis c, and rheumatoid arthritis. 21
103103 (2) "Pre-service authorization" means a cost containment method that an insurer, a 22
104104 nonprofit health service plan, or a health maintenance organization uses to review and preauthorize 23
105105 coverage for drugs prescribed by a health care provider for a covered individual to control 24
106106 utilization, quality, and claims. 25
107107 (3) "Rare medical condition" means a disease or condition that affects fewer than: 26
108108 (i) Two hundred thousand (200,000) individuals in the United States; or 27
109109 (ii) Approximately one in one thousand five hundred (1,500) individuals worldwide. 28
110110 "Rare medical condition" includes, but is not limited to, cystic fibrosis, hemophilia, and 29
111111 multiple myeloma. 30
112-(4) "Specialty drug" means a prescription drug that exceeds the threshold for a specialty 31
113-drug under the Medicare Part D program (Medicare Prescription Drug Improvement and 32
114-Modernization Act of 2003 (Public Law 108-173)). 33
115-(5) "Specialty drug tier" means a formulary tier in the pharmacy benefit that imposes a 34
112+(4) "Specialty drug" means a prescription drug that: 31
113+(i) Is prescribed for an individual with a complex or chronic medical condition or a rare 32
114+medical condition; and 33
115+(ii) Has a wholesale acquisition cost or negotiated price that exceeds the Medicare Part D 34
116116
117117
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119-cost-sharing obligation for a specialty drug. 1
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119+specialty tier threshold, as updated from time to time. 1
120120 (c) Every individual or group health insurance contract, plan or policy that provides 2
121-prescription drug coverage and is delivered, issued for delivery or renewed in this state on or after 3
122-January 1, 2025, shall limit any required copayment of coinsurance applicable to covered drugs on 4
123-a specialty drug tier to an amount not to exceed one hundred fifty dollars ($150) per month for each 5
124-drug up to a thirty-day (30) supply of any single drug. This limit shall be inclusive of any copayment 6
125-or coinsurance. This limit shall be applicable after any deductible is reached and until the 7
126-individual's maximum out-of-pocket limit has been reached. 8
127-(d) Nothing in this section shall prevent an entity subject to this section from reducing a 9
128-covered individual's cost sharing for a specialty drug to an amount less than that described in section 10
129-(c) of this section. 11
121+prescription coverage and is delivered, issued for delivery or renewed in this state on or after 3
122+January 1, 2024, shall not impose a copayment or coinsurance requirement on a covered specialty 4
123+drug that exceeds one hundred fifty dollars ($150) for up to a thirty (30)-day supply of the specialty 5
124+drug. A pre-service authorization may be used to provide coverage for specialty drugs. Coverage 6
125+for prescription specialty drugs shall not be subject to any deductible, unless prohibiting a 7
126+deductible requirement would cause a health plan to not qualify as a high deductible health plan. 8
127+(d) Nothing in this section prevents an insurer, health maintenance plan, or nonprofit 9
128+medical plan from reducing a covered individual's cost sharing to an amount less than one hundred 10
129+fifty dollars ($150) for a thirty (30)-day supply of a specialty drug. 11
130130 (e) The health insurance commissioner may promulgate any rules and regulations 12
131131 necessary to implement and administer this section in accordance with any federal requirements 13
132132 and shall use the commissioner's enforcement powers to obtain compliance with the provisions of 14
133133 this section. 15
134134 SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 16
135135 Corporations" is hereby amended by adding thereto the following section: 17
136136 27-20-37.1. Specialty drugs. 18
137137 (a) The general assembly makes the following findings: 19
138138 (1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents 20
139139 had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) 21
140140 residents had two (2) or more chronic diseases, which significantly increases their likelihood to 22
141141 depend on prescription specialty drugs; 23
142142 (2) In 2016, twenty-five percent (25%) of Rhode Island residents stopped taking a 24
143143 prescription drug as prescribed due to cost; 25
144144 (3) Most specialty drugs do not have biosimilars, generic equivalents, or substitutes to 26
145145 create competition and help lower their prices; and 27
146146 (4) In 2022, the Centers for Medicare and Medicaid Services define any drug for which the 28
147147 negotiated price is six hundred seventy dollars ($670) per month or more, as a specialty drug. 29
148148 (b) As used in this section, the following words shall have the following meanings: 30
149149 (1) "Complex or chronic medical condition" means a physical, behavioral, or 31
150150 developmental condition that is persistent or otherwise long-lasting in its effects or a disease that 32
151151 advances over time, and: 33
152152 (i) May have no known cure; 34
153153
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156156 (ii) Is progressive; or 1
157157 (iii) Can be debilitating or fatal if left untreated or undertreated. 2
158158 "Complex or chronic medical condition" includes, but is not limited to, multiple sclerosis, 3
159159 hepatitis c, and rheumatoid arthritis. 4
160160 (2) "Pre-service authorization" means a cost containment method that an insurer, a 5
161161 nonprofit health service plan, or a health maintenance organization uses to review and preauthorize 6
162162 coverage for drugs prescribed by a health care provider for a covered individual to control 7
163163 utilization, quality, and claims. 8
164164 (3) "Rare medical condition" means a disease or condition that affects fewer than: 9
165165 (i) Two hundred thousand (200,000) individuals in the United States; or 10
166166 (ii) Approximately one in one thousand five hundred (1,500) individuals worldwide. 11
167167 "Rare medical condition" includes, but is not limited to, cystic fibrosis, hemophilia, and 12
168168 multiple myeloma. 13
169-(4) "Specialty drug" means a prescription drug that exceeds the threshold for a specialty 14
170-drug under the Medicare Part D program (Medicare Prescription Drug Improvement and 15
171-Modernization Act of 2003 (Public Law 108-173)). 16
172-(5) "Specialty drug tier" means a formulary tier in the pharmacy benefit that imposes a 17
173-cost-sharing obligation for a specialty drug. 18
174-(c) Every individual or group health insurance contract, plan or policy that provides 19
175-prescription drug coverage and is delivered, issued for delivery or renewed in this state on or after 20
176-January 1, 2025, shall limit any required copayment of coinsurance applicable to covered drugs on 21
177-a specialty drug tier to an amount not to exceed one hundred fifty dollars ($150) per month for each 22
178-drug up to a thirty-day (30) supply of any single drug. This limit shall be inclusive of any copayment 23
179-or coinsurance. This limit shall be applicable after any deductible is reached and until the 24
180-individual's maximum out-of-pocket limit has been reached. 25
181-(d) Nothing in this section shall prevent an entity subject to this section from reducing a 26
182-covered individual's cost sharing for a specialty drug to an amount less than that described in section 27
183-(c) of this section. 28
184-(e) The health insurance commissioner may promulgate any rules and regulations 29
185-necessary to implement and administer this section in accordance with any federal requirements 30
186-and shall use the commissioner's enforcement powers to obtain compliance with the provisions of 31
187-this section. 32
188-SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 33
189-Organizations" is hereby amended by adding thereto the following section: 34
169+(4) "Specialty drug" means a prescription drug that: 14
170+(i) Is prescribed for an individual with a complex or chronic medical condition or a rare 15
171+medical condition; and 16
172+(ii) Has a wholesale acquisition cost or negotiated price that exceeds the Medicare Part D 17
173+specialty tier threshold, as updated from time to time. 18
174+(iii) Is not typically stocked at retail pharmacies; and 19
175+(iv)(A) Requires a difficult or unusual process of delivery to the patient in the preparation, 20
176+handling, storage, inventory, or distribution of the drug; or 21
177+(B) Requires enhanced patient education, management, or support, beyond those required 22
178+for traditional dispensing, before or after administration of the drug. 23
179+(c) Every individual or group health insurance contract, plan or policy that provides 24
180+prescription coverage and is delivered, issued for delivery or renewed in this state on or after 25
181+January 1, 2024, shall not impose a copayment or coinsurance requirement on a covered specialty 26
182+drug that exceeds one hundred fifty dollars ($150) for up to a thirty (30)-day supply of the specialty 27
183+drug. A pre-service authorization may be used to provide coverage for specialty drugs. Coverage 28
184+for prescription specialty drugs shall not be subject to any deductible, unless prohibiting a 29
185+deductible requirement would cause a health plan to not qualify as a high deductible health plan. 30
186+(d) Nothing in this section prevents an insurer, health maintenance plan, or nonprofit 31
187+medical plan from reducing a covered individual's cost sharing to an amount less than one hundred 32
188+fifty dollars ($150) for a thirty (30)-day supply of a specialty drug. 33
189+(e) The health insurance commissioner may promulgate any rules and regulations 34
190190
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193-27-41-38.3. Specialty drugs. 1
194-(a) The general assembly makes the following findings: 2
195-(1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents 3
196-had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) 4
197-residents had two (2) or more chronic diseases, which significantly increases their likelihood to 5
198-depend on prescription specialty drugs; 6
199-(2) In 2016, twenty-five percent (25%) of Rhode Island residents stopped taking a 7
200-prescription drug as prescribed due to cost; 8
201-(3) Most specialty drugs do not have biosimilars, generic equivalents, or substitutes to 9
202-create competition and help lower their prices; and 10
203-(4) In 2022, the Centers for Medicare and Medicaid Services define any drug for which the 11
204-negotiated price is six hundred seventy dollars ($670) per month or more, as a specialty drug. 12
205-(b) As used in this section, the following words shall have the following meanings: 13
206-(1) "Complex or chronic medical condition" means a physical, behavioral, or 14
207-developmental condition that is persistent or otherwise long-lasting in its effects or a disease that 15
208-advances over time, and: 16
209-(i) May have no known cure; 17
210-(ii) Is progressive; or 18
211-(iii) Can be debilitating or fatal if left untreated or undertreated. 19
212-"Complex or chronic medical condition" includes, but is not limited to, multiple sclerosis, 20
213-hepatitis c, and rheumatoid arthritis. 21
214-(2) "Pre-service authorization" means a cost containment method that an insurer, a 22
215-nonprofit health service plan, or a health maintenance organization uses to review and preauthorize 23
216-coverage for drugs prescribed by a health care provider for a covered individual to control 24
217-utilization, quality, and claims. 25
218-(3) "Rare medical condition" means a disease or condition that affects fewer than: 26
219-(i) Two hundred thousand (200,000) individuals in the United States; or 27
220-(ii) Approximately one in one thousand five hundred (1,500) individuals worldwide. 28
221-"Rare medical condition" includes, but is not limited to, cystic fibrosis, hemophilia, and 29
222-multiple myeloma. 30
223-(4) "Specialty drug" means a prescription drug that exceeds the threshold for a specialty 31
224-drug under the Medicare Part D program (Medicare Prescription Drug Improvement and 32
225-Modernization Act of 2003 (Public Law 108-173)). 33
226-(5) "Specialty drug tier" means a formulary tier in the pharmacy benefit that imposes a 34
192+LC000200 - Page 6 of 8
193+necessary to implement and administer this section in accordance with any federal requirements 1
194+and shall use the commissioner's enforcement powers to obtain compliance with the provisions of 2
195+this section. 3
196+SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 4
197+Organizations" is hereby amended by adding thereto the following section: 5
198+27-41-38.3. Specialty drugs. 6
199+(a) The general assembly makes the following findings: 7
200+(1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents 8
201+had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) 9
202+residents had two (2) or more chronic diseases, which significantly increases their likelihood to 10
203+depend on prescription specialty drugs; 11
204+(2) In 2016, twenty-five percent (25%) of Rhode Island residents stopped taking a 12
205+prescription drug as prescribed due to cost; 13
206+(3) Most specialty drugs do not have biosimilars, generic equivalents, or substitutes to 14
207+create competition and help lower their prices; and 15
208+(4) In 2022, the Centers for Medicare and Medicaid Services define any drug for which the 16
209+negotiated price is six hundred seventy dollars ($670) per month or more, as a specialty drug. 17
210+(b) As used in this section, the following words shall have the following meanings: 18
211+(1) "Complex or chronic medical condition" means a physical, behavioral, or 19
212+developmental condition that is persistent or otherwise long-lasting in its effects or a disease that 20
213+advances over time, and: 21
214+(i) May have no known cure; 22
215+(ii) Is progressive; or 23
216+(iii) Can be debilitating or fatal if left untreated or undertreated. 24
217+"Complex or chronic medical condition" includes, but is not limited to, multiple sclerosis, 25
218+hepatitis c, and rheumatoid arthritis. 26
219+(2) "Pre-service authorization" means a cost containment method that an insurer, a 27
220+nonprofit health service plan, or a health maintenance organization uses to review and preauthorize 28
221+coverage for drugs prescribed by a health care provider for a covered individual to control 29
222+utilization, quality, and claims. 30
223+(3) "Rare medical condition" means a disease or condition that affects fewer than: 31
224+(i) Two hundred thousand (200,000) individuals in the United States; or 32
225+(ii) Approximately one in one thousand five hundred (1,500) individuals worldwide. 33
226+"Rare medical condition" includes, but is not limited to, cystic fibrosis, hemophilia, and 34
227227
228228
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230-cost-sharing obligation for a specialty drug. 1
231-(c) Every individual or group health insurance contract, plan or policy that provides 2
232-prescription drug coverage and is delivered, issued for delivery or renewed in this state on or after 3
233-January 1, 2025, shall limit any required copayment of coinsurance applicable to covered drugs on 4
234-a specialty drug tier to an amount not to exceed one hundred fifty dollars ($150) per month for each 5
235-drug up to a thirty-day (30) supply of any single drug. This limit shall be inclusive of any copayment 6
236-or coinsurance. This limit shall be applicable after any deductible is reached and until the 7
237-individual's maximum out-of-pocket limit has been reached. 8
238-(d) Nothing in this section shall prevent an entity subject to this section from reducing a 9
239-covered individual's cost sharing for a specialty drug to an amount less than that described in section 10
240-(c) of this section. 11
241-(e) The health insurance commissioner may promulgate any rules and regulations 12
242-necessary to implement and administer this section in accordance with any federal requirements 13
243-and shall use the commissioner's enforcement powers to obtain compliance with the provisions of 14
244-this section. 15
245-SECTION 5. This act shall take effect on January 1, 2025. 16
229+LC000200 - Page 7 of 8
230+multiple myeloma. 1
231+(4) "Specialty drug" means a prescription drug that: 2
232+(i) Is prescribed for an individual with a complex or chronic medical condition or a rare 3
233+medical condition; and 4
234+(ii) Has a wholesale acquisition cost or negotiated price that exceeds the Medicare Part D 5
235+specialty tier threshold, as updated from time to time. 6
236+(c) Every individual or group health insurance contract, plan or policy that provides 7
237+prescription coverage and is delivered, issued for delivery or renewed in this state on or after 8
238+January 1, 2024, shall not impose a copayment or coinsurance requirement on a covered specialty 9
239+drug that exceeds one hundred fifty dollars ($150) for up to a thirty (30)-day supply of the specialty 10
240+drug. A pre-service authorization may be used to provide coverage for specialty drugs. Coverage 11
241+for prescription specialty drugs shall not be subject to any deductible, unless prohibiting a 12
242+deductible requirement would cause a health plan to not qualify as a high deductible health plan. 13
243+(d) Nothing in this section prevents an insurer, health maintenance plan, or nonprofit 14
244+medical plan from reducing a covered individual's cost sharing to an amount less than one hundred 15
245+fifty dollars ($150) for a thirty (30)-day supply of a specialty drug. 16
246+(e) The health insurance commissioner may promulgate any rules and regulations 17
247+necessary to implement and administer this section in accordance with any federal requirements 18
248+and shall use the commissioner's enforcement powers to obtain compliance with the provisions of 19
249+this section. 20
250+SECTION 5. This act shall take effect upon passage. 21
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252257 EXPLANATION
253258 BY THE LEGISLATIVE COUNCIL
254259 OF
255260 A N A C T
256261 RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
257262 ***
258263 This act would limit the copayment or coinsurance requirement on specialty drugs to one 1
259264 hundred fifty dollars ($150) for a thirty (30)-day supply regarding any specialty drug in any 2
260265 individual or health insurance contract, plan or policy issued, delivered or renewed on or after 3
261-January 1, 2025. Specialty drugs would be defined as a drug prescribed to an individual with a 4
266+January 1, 2024. Specialty drugs would be defined as a drug prescribed to an individual with a 4
262267 complex or chronic medical condition or a rare medical condition. 5
263-This act would take effect on January 1, 2025. 6
268+This act would take effect upon passage. 6
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