HB5721 Summary

• Amends the Insurance Code of 1956 to establish requirements for health insurers offering prescription drug coverage with formularies, including physician and pharmacist participation in formulary development and disclosure of restrictions to providers and insureds.

• Requires insurers to provide exceptions from formulary limitations when a nonformulary drug is medically necessary and appropriate, with expedited review within 24 hours for exigent circumstances and standard review within 72 hours.

• Adds new section 3406v requiring insurers to cover emergency refills of up to a 60-day supply of any noncontrolled maintenance medication during the state of emergency declared under Executive Order No. 2020-4 or any extension thereof.

• Mandates insurers provide coverage for early refills of 30-day or 60-day prescription maintenance drugs to allow up to a 90-day supply during the declared state of emergency, regardless of whether the pharmacy is mail order or in-person.