Bill Text: HI SB301 | 2015 | Regular Session | Amended

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Bill Title: Drug Formulary; Posting Requirements; Insurers; Health Plan

Spectrum: Partisan Bill (Democrat 9-0)

Status: (Engrossed - Dead) 2015-03-25 - The committee(s) on CPC recommend(s) that the measure be deferred. [SB301 Detail]

Download: Hawaii-2015-SB301-Amended.html

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THE SENATE	S.B. NO.	301
TWENTY-EIGHTH LEGISLATURE, 2015		S.D. 2
STATE OF HAWAII		H.D. 1

A BILL FOR AN ACT

 

 

RELATING TO HEALTH.

 

 

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

 

     SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

     "§431:10A-    Formulary; accessibility requirements.  (a)  Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information required by this section via a public website and through a toll-free number that is posted on the insurer's website:

     (1)  Its formulary; provided that any changes because of the addition of a new drug, or deletion of any existing drug, shall be made no later than seventy-two hours after the effective date of the change; provided further that other changes, including drug strength or form, shall be made within fourteen calendar days of the effective date of the change;

     (2)  Provide a system that allows an insured or potential insured to determine whether prescription drugs are covered under the plan's medical benefits and typically administered by a provider, along with any cost-sharing imposed on the drugs;

     (3)  Provide a dollar amount range of cost sharing typically paid by an insured of each specific drug included on the formulary and based on the information the insurer has available, as follows:

          (A)  Under $100-$;

          (B)  $100-$250-$$;

          (C)  Over $250-$500-$$$;

          (D)  Over $500-$1000-$$$$; and

          (E)  Over $1000-$$$$$; and

     (4)  Display standardized content for the formulary for each product offered by the plan pursuant to recommendations made by the formulary accessibility working group.

     (b)  For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy, including drugs covered under the policy's pharmacy benefit and medical benefit, as defined by the health care service plans.

     (c)  This section shall not apply to limited benefit health insurance as provided in section 431:10A-102.5, Medicare, Medicaid, or any other federally financed plan."

     SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

     "§432:1-    Formulary; accessibility requirements.  (a)  Each mutual benefit society offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information required by this section via a public website and through a toll-free number that is posted on the mutual benefit society's website:

     (1)  Its formulary; provided that any changes because of the addition of a new drug, or deletion of any existing drug, shall be made no later than seventy-two hours after the effective date of the change; provided further that other changes, including drug strength or form, shall be made within fourteen calendar days of the effective date of the change;

     (2)  Provide a system that allows an insured or potential insured to determine whether prescription drugs are covered under the plan's medical benefits and typically administered by a provider, along with any cost-sharing imposed on the drugs;

     (3)  Provide a dollar amount range of cost sharing typically paid by an insured of each specific drug included on the formulary and based on the information the mutual benefit society has available, as follows:

          (A)  Under $100-$;

          (B)  $100-$250-$$;

          (C)  Over $250-$500-$$$;

          (D)  Over $500-$1000-$$$$; and

          (E)  Over $1000-$$$$$; and

     (4)  Display standardized content for the formulary for each product offered by the plan pursuant to recommendations made by the formulary accessibility working group.

     (b)  For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy, including drugs covered under the policy's pharmacy benefit and medical benefit, as defined by the health care service plans.

     (c)  This section shall not apply to limited benefit health insurance as provided in section 431:10A-102.5, Medicare, Medicaid, or any other federally financed plan."

     SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

     "§432D-    Formulary; accessibility requirements.  (a)  Each health maintenance organization offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information required by this section via a public website and through a toll-free number that is posted on the health maintenance organization's website:

     (1)  Its formulary; provided that any changes because of the addition of a new drug, or deletion of any existing drug, shall be made no later than seventy-two hours after the effective date of the change; provided further that other changes, including drug strength or form, shall be made within fourteen calendar days of the effective date of the change;

     (2)  Provide a system that allows an insured or potential insured to determine whether prescription drugs are covered under the plan's medical benefits and typically administered by a provider, along with any cost-sharing imposed on the drugs;

     (3)  Provide a dollar amount range of cost sharing typically paid by an insured of each specific drug included on the formulary and based on the information the insurer has available, as follows:

          (A)  Under $100-$;

          (B)  $100-$250-$$;

          (C)  Over $250-$500-$$$;

          (D)  Over $500-$1000-$$$$; and

          (E)  Over $1000-$$$$$; and

     (4)  Display standardized content for the formulary for each product offered by the health maintenance organization pursuant to recommendations made by the formulary accessibility working group.

     (b)  For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy, including drugs covered under the policy's pharmacy benefit and medical benefit, as defined by the health care service plans.

     (c)  This section shall not apply to limited benefit health insurance as provided in section 431:10A-102.5, Medicare, Medicaid, or any other federally financed plan."

     SECTION 4.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, [431:10A-122, and 431:10A-116.2,] and 431:10A‑   , and chapter 431M."

     SECTION 5.  (a)  There is established a formulary accessibility working group to be appointed and administered by the insurance commissioner for the purposes of making recommendations for a standard formulary template pursuant to subsection (a) of 431:10A   , Hawaii Revised Statutes, and shall include the following members:

     (1)  The insurance commissioner, or the commissioner's designee, who shall serve as chair;

     (2)  The director of health, or the director's designee;

     (3)  Representatives from the health care provider community;

     (4)  Representatives from the board of pharmacy;

     (5)  Representatives from the Hawaii association of health plans; and

     (6)  A representative from the Hawaii pacific region of the American cancer society cancer action network.

     (b)  The formulary accessibility working group shall submit its recommendations to the legislature no later than twenty days prior to the convening of the regular session of 2016.
     SECTION 6.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 7.  This Act shall take effect on July 1, 2112.

 

 

Report Title:

Drug Formulary; Posting Requirements; Insurers; Health Plan

 

Description:

Requires health insurers, mutual benefit societies, and health maintenance organizations to post and update information on drug formularies on their websites for the benefit of insureds, potential insureds, and providers.  Establishes a formulary accessibility working group.  (SB301 HD1)

 

 

 

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