DE SB252

Caps monthly copayments and coinsurance for prescription drugs at $100 per month for a 30-day supply of any single drug and $200 per month aggregate for all covered drugs.

Requires health plans using tiered formularies to establish an exceptions process allowing enrollees to request lower cost-sharing for non-preferred drugs if the prescribing physician determines preferred alternatives would be ineffective or cause adverse effects.

Prohibits health plans from placing drugs on specialty tiers when only one drug class is available for treatment of a condition.

Treats denials of cost-sharing exceptions as adverse events subject to internal and external review processes under Delaware insurance law.

Applies to health plan contracts issued, amended, or renewed on or after January 1, 2013, and does not restrict plans' use of tiered structures, utilization management techniques, or prior authorization requirements.