CS/HB 1001 - Health Care Summary

• Establishes requirements for managed care plans' drug formularies to include at least two products per therapeutic class and provide prior authorization coverage for newly FDA-approved drugs until review is complete.

• Creates a 24-hour override process allowing prescribing providers to request exceptions to step-therapy and fail-first protocols when the preferred treatment is ineffective or likely to cause harm based on clinical evidence.

• Prohibits health insurers and HMOs from retroactively denying claims based on insured ineligibility more than 1 year after payment, or at all if the insurer verified eligibility at time of treatment and provided an authorization number.

• Requires health insurers to post preferred provider lists on their websites with 24-hour updates and mandates managed care plans maintain accurate, searchable online provider databases with patient feedback capabilities.

• Repeals grace period provisions for health insurance and HMO contracts; effective July 1, 2014.