HB 5009 Summary

• Beginning with the 2021 plan year, the Department of Management Services must simultaneously procure contracts for insurance plans, health maintenance organization (HMO) plans, and pharmacy benefit plans.

• Health maintenance organization plans must be negotiated on a regional or statewide basis when cost-effective and offering high value to enrollees, changing from discretionary to mandatory negotiation.

• International prescription services must be offered as a voluntary supplemental benefit option meeting FDA personal importation policy standards.

• The department must implement formulary management cost-saving measures that require prescription drugs to be subject to formulary inclusion or exclusion while maintaining access to clinically appropriate and lowest net-cost drugs.

• Benefits consulting companies must be contracted with by the department under state term contracts, and prior authorization and restricted formulary programs for non-HMO enrollees are prohibited beyond generic equivalent and starter dose provisions.