DE SB35

Caps specialty tier prescription drug copayments and coinsurance at $100 per month for up to a 30-day supply of any single drug, with an aggregate monthly limit of $200 per enrollee across all specialty tier drugs.

Requires health plans to implement an exceptions process allowing enrollees to request cost-sharing exceptions when prescribing physicians determine preferred drugs would be ineffective or cause adverse effects.

Prohibits health plans from placing all drugs in a given class on a specialty tier and establishes that denials of cost-sharing exceptions are subject to internal and external review processes.

Requires the Insurance Commissioner to promulgate regulations for enforcement and allows health plans to continue utilizing tiered cost-sharing structures, prior authorization, and step therapy.

Takes effect January 1, 2014, and applies to health plan contracts issued, amended, or renewed on or after that date.