HB15 Summary

• Caps patient cost-sharing for specialty tier prescription drugs at $150 per month for up to a 30-day supply of any single specialty drug across all health insurance plans in Hawaii.

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

• Prohibits insurers from placing all drugs within a given drug class on a 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, disability insurance, hospital and medical service corporation contracts, and health maintenance organization plans issued or renewed on or after January 1, 2022.

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