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GA HB875
Bill
Status
Introduced
1/28/2016
Primary Sponsor
Lee Hawkins
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AI Summary
- Caps out-of-pocket cost sharing for covered specialty drugs at $200.00 per 30-day supply per individual prescription, $1,000.00 per insured per plan year, and $2,000.00 per insured family per plan year
- Requires health benefit policy issuers to post all prescription drug formularies, drug costs, prior authorization information, and standardized drug tier definitions on their websites in plain language, and to establish a dedicated pharmacy consumer service phone line
- Mandates an exception approval process allowing physicians to request coverage of nonformulary specialty drugs if the formulary alternative would be less effective or cause adverse effects; denials must be subject to internal and applicable state review processes
- Prohibits changes to prior authorization approvals for specialty drugs during a plan year and, effective January 1, 2017, requires issuers to honor previous prior authorizations for 90 days when a person with a chronic condition acquires a new health benefit policy from the issuer
- Defines "specialty drug" as any generic or brand name drug identified by an issuer as a high-cost drug used to treat complex or rare medical conditions
Legislative Description
"Patient Access to Specialty Tier Drugs Act"; enact
Last Action
House Second Readers
2/2/2016
Full Bill Text
No bill text available