HB 1504 Summary

• Limits copayments and coinsurance for specialty tier drugs to a maximum of $100.00 per month for a 30-day supply of any single drug.

• Caps aggregate monthly copayments or coinsurance for all specialty tier drugs at $200.00 per month per enrollee.

• Requires health plans with tiered formularies to implement an exceptions process allowing enrollees to request preferred drug cost-sharing for non-preferred drugs when the preferred drug would be less effective or cause adverse effects.

• Denials of cost-sharing exceptions are subject to external review under the Uniform Health Carrier External Review Act.

• Prohibits health plans from placing all drugs in a given class on a specialty tier and authorizes the Insurance Commissioner to promulgate enforcement regulations.

• Effective November 1, 2015.