15RS House Bill 146

House Bill 146

Actions

Last Action	to Banking & Insurance (H)
Title	AN ACT relating to health benefit plans which include a tiered formulary for prescription drugs.
Bill Documents	Bill
Impact Statements	Health Mandate
Bill Request Number	946
Sponsors	J. Kay, R. Crimm, J. Donohue, M. Marzian, M. Meredith, J. Wayne
Summary of Original Version	Create new sections of Subtitle 17A of KRS Chapter 304 to define terms; require health benefit plans that provide coverage for prescription drugs subject to a tiered formulary to ensure that any out-of-pocket expenditure shall not exceed $100 per month for up to a 30-day supply, and that out-of-pocket expenditures for drugs subject to a tiered formulary shall not exceed $200 per month in the aggregate; require an exceptions process for tiered formulary plans that allows an insured to request an exception to the tiered cost-sharing structure, including coverage of a non-preferred drug under the cost sharing, applicable for preferred drugs if the prescribing physician determines that the preferred drug would not be as effective or would have an adverse effect, or both, for the insured, and denial of a cost-sharing exception shall be subject to an external review; prohibit placing all drugs of the same class in a specialty tier; require the insurance commissioner to promulgate administrative regulations to implement this section; provide that nothing in the section requires coverage of any drugs not otherwise required by law, specific utilization management techniques, or ceasing utilization of tiered cost-sharing structure; provide that nothing in the section is to be construed to require a pharmacist to substitute a drug without the written consent of the prescribing physician; provide that the new sections apply to health benefit plans issued, amended, or renewed on or after January 1, 2016.
Index Headings of Original Version	Health and Medical Services - Prescription drugs, health plan out of pocket expenditures, establish Insurance - Health insurance, prescription drug costs, establish maximum out-of-pocket expenditure Insurance, Health - Prescription drug costs, insureds maximum out-of-pocket expenditure, establish Health Benefit Mandate - Out-of-pocket expenditures for prescription drugs, establish maximum Administrative Regulations and Proceedings - Finanicial Institutions, health plan prescription drug cost coverage Health Benefit Mandate - Prescription drug costs, insureds maximum out-of-pocket expenditure, establish

01/08/15	introduced in House
01/09/15	to Banking & Insurance (H)