HB 15 Summary

• Limits out-of-pocket costs for specialty tier prescription drugs to a maximum of $150 per month for a 30-day supply of any single specialty drug across all health insurance plans in Hawaii.

• Requires all health insurance plans using specialty drug formularies to implement an exceptions process allowing patients to request coverage of non-formulary specialty drugs if the prescribing physician determines the formulary drug would be less effective or cause adverse effects.

• Prohibits health insurance plans from placing all drugs in a given drug class on the specialty tier, ensuring at least some drugs in each class are available at lower cost-sharing levels.

• Applies to individual and group accident and health insurance policies, disability insurance, hospital and medical service corporation contracts, and health maintenance organization plans.

• Takes effect July 1, 2021, but applies to health plan contracts issued or renewed on or after January 1, 2022.