HB 915 - Continuity of Care for Medically Stable Patients

• Prohibits insurance policies, HMO contracts, and pharmacy benefit managers from limiting, excluding, or increasing patient costs for drugs previously approved for coverage when treating complex/chronic or rare medical conditions, provided the prescribing provider continues prescribing the drug and it remains safe and effective.

• Defines "complex or chronic medical condition" as a physical, behavioral, or developmental condition with no known cure or that can be severely debilitating or fatal if untreated, and "rare medical condition" as affecting fewer than 200,000 individuals in the United States or approximately 1 in 1,500 worldwide.

• Prohibits insurers from moving previously covered drugs to more expensive formulary tiers unless the contract is being renewed, but allows formulary changes that do not exclude previously covered drugs for continuing patients.

• Allows generic drug substitutions by pharmacists despite the continuity of care protections.

• Applies requirements to individual policies, group health insurance, blanket health insurance, franchise health insurance, and HMO contracts, effective January 1, 2017.