Bill Text: HI HB664 | 2012 | Regular Session | Introduced

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Bill Title: Health Insurance; Immunosuppressant Drugs; Post-Operative Transplant Patients

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2011-12-01 - Carried over to 2012 Regular Session. [HB664 Detail]

Download: Hawaii-2012-HB664-Introduced.html

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HOUSE OF REPRESENTATIVES	H.B. NO.	664
TWENTY-SIXTH LEGISLATURE, 2011
STATE OF HAWAII

A BILL FOR AN ACT

 

 

relating to health.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  Chapter 328, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§328‑A  Immunosuppressant drugs; no substitution; post-operative transplant patients.  (a)  When a prescribing physician has prescribed an immunosuppressant drug and has indicated "do not substitute" on the prescription, a pharmacist shall not substitute or interchange another immunosuppressant drug or formulation if the immunosuppressant drug or formulation is issued to inhibit or prevent the activity of the immune system of a patient to prevent the rejection of transplanted organs and tissues.  A pharmacist may substitute or interchange another immunosuppressant drug or formulation if the pharmacist has been notified and has received the documented consent of:

     (1)  The prescribing physician and patient;

     (2)  The parent or guardian if the patient is a child; or

     (3)  The spouse of a patient who is authorized to consent to the treatment of the person.

     (b)  For the purposes of this section, the term "immunosuppressant drugs" means drugs that are used in immunosuppressive therapy to inhibit or prevent the activity of the immune system and that are used clinically to prevent the rejection of transplanted organs and tissues, but does not include drugs for the treatment of autoimmune diseases or diseases that are most likely of autoimmune origin."

     SECTION 2.  Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to part I to be appropriately designated and to read as follows:

     "§431:10A‑B  Immunosuppressant drugs; post-operative transplant patients; same charges.  (a)  Except as provided in subsections (b) and (c), insured co-payments, deductibles, or other charges for the prescribed drug for which another immunosuppressant drug or formulation is not interchanged shall remain the same for the agreement period established by a policy of accident and health or sickness insurance.

     (b)  No less than sixty days prior to making any formulary change that alters the terms of coverage for an insured receiving immunosuppressant drugs or discontinues coverage for a prescribed immunosuppressant drug that an insured is receiving, a health insurer under this part shall notify:

     (1)  The prescribing physician and the insured;

     (2)  The insured, if the patient is a covered dependent; or

     (3)  The spouse of an insured who is authorized to consent to the treatment of the insured.

The notification shall be in writing and shall disclose the formulary change, indicate that the prescribing physician may initiate an appeal, and include information regarding the procedure for the prescribing physician to initiate the policy's appeal process; provided that if the insured affirmatively elects to receive notice electronically, the notice may be provided electronically.

     (c)  At the time an insured requests a refill of the immunosuppressant drug, the insured may be provided the written notification required along with a sixty-day supply of the immunosuppressant drug under the same terms as previously allowed.

     (d)  For the purposes of this section, the term "immunosuppressant drugs" has the same meaning as in section 328-A(b).

     (e)  Nothing in this section shall prohibit insurers or pharmacy benefit managers from using managed pharmacy care tools, including but not limited to formulary tiers, generic substitution, therapeutic interchange, prior authorization, or step therapy, so long as an exception process is in place allowing the prescriber to petition for coverage of a non-preferred drug if sufficient clinical reasons justify an exception to the normal protocol."

     SECTION 3.  Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to part II to be appropriately designated and to read as follows:

     "§431:10A-C  Immunosuppressant drugs; no substitution; post-operative transplant patients.  Every person insured under a group or blanket disability insurance policy shall be entitled to the benefits specified in section 431:10A-B."

     SECTION 4.  Chapter 432, article 1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§432:1‑D  Immunosuppressant drugs; post-operative transplant patients; same charges.  (a)  Except as provided in subsections (b) and (c), subscriber or member co-payments, deductibles, or other charges for the prescribed drug for which another immunosuppressant drug or formulation is not interchanged shall remain the same for the agreement period established by an individual and group hospital or medical service plan, policy, contract, or agreement.

     (b)  No less than sixty days prior to making any formulary change that alters the terms of coverage for a subscriber or member receiving immunosuppressant drugs or discontinues coverage for a prescribed immunosuppressant drug that a subscriber or member is receiving, an individual and group hospital or medical service plan, policy, contract, or agreement under this article shall notify:

     (1)  The prescribing physician and the subscriber or member;

     (2)  The subscriber or member, if the patient is a covered dependent; or

     (3)  The spouse of a subscriber or member who is authorized to consent to the treatment of the subscriber or member.

The notification shall be in writing and shall disclose the formulary change, indicate that the prescribing physician may initiate an appeal, and include information regarding the procedure for the prescribing physician to initiate the agreement's appeal process; provided that if the subscriber or member affirmatively elects to receive notice electronically, the notice may be provided electronically.

     (c)  At the time a subscriber or member requests a refill of the immunosuppressant drug, the subscriber or member may be provided the written notification required along with a sixty-day supply of the immunosuppressant drug under the same terms as previously allowed.

     (d)  For the purposes of this section, the term "immunosuppressant drugs" has the same meaning as in section 328-A(b).

     (e)  Nothing in this section shall prohibit an individual and group hospital or medical service plan, policy, contract, or agreement or a pharmacy benefit manager from using managed pharmacy care tools, including but not limited to formulary tiers, generic substitution, therapeutic interchange, prior authorization, or step therapy, so long as an exception process is in place allowing the prescriber to petition for coverage of a non-preferred drug if sufficient clinical reasons justify an exception to the normal protocol."

     SECTION 5.  Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

     "§432D-23  Required provisions and benefits.  Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-125, 431:10A-126, [and] 431:10A-122, and 431:10A-B, and chapter 431M."

     SECTION 6.  In codifying the new sections added by sections 1, 2, 3, and 4 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

     SECTION 7.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 8.  This Act shall take effect upon its approval.

 

INTRODUCED BY:	_____________________________

 

Report Title:

Health Insurance; Immunosuppressant Drugs; Post-Operative Transplant Patients

 

Description:

Prohibits pharmacists, health insurers, mutual benefit societies, and health maintenance organizations from substituting medications prescribed to post-operative transplant patients when a prescribing physician indicates "do not substitute".

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.