Loading chat...
IN SB0585
Bill
Status
1/14/2019
Primary Sponsor
Elizabeth Brown
Click for details
AI Summary
-
Prohibits state employee health plans, Medicaid programs, accident and sickness insurers, and health maintenance organizations from imposing limitations or exclusions on prescription drug coverage for continuously enrolled individuals who are currently prescribed the drug for the same medical condition
-
Defines "limitation or exclusion of coverage" to include removing drugs from formularies, increasing out-of-pocket costs, moving drugs to more restrictive tiers, and reducing maximum drug benefits during a person's continuous enrollment
-
Requires health plans to respond to coverage exception requests within 72 hours (or 24 hours for urgent requests), with requests automatically granted if no response is provided within the deadline
-
Mandates that when a plan is discontinued during open enrollment and an enrollee switches to a comparable plan from the same insurer, the new plan must grant coverage exceptions to maintain equivalent drug coverage
-
Effective date of July 1, 2019, with violations by insurers and HMOs classified as unfair and deceptive acts under Indiana insurance law
Legislative Description
Continuous prescription drug coverage. Prohibits state employee health plans, Medicaid programs, accident and sickness insurers, and health maintenance organizations from changing coverage of a prescribed drug during the continuous enrollment of a covered individual, recipient, or enrollee. Specifies requirements for coverage exception requests and discontinuation of certain coverage.
Last Action
First reading: referred to Committee on Health and Provider Services
1/14/2019