SC H4795

Health benefit plan issuers may only modify drug coverage at the time of coverage renewal and must apply changes uniformly among all enrollees with identical or substantially identical plans

Issuers must provide written notice to the Insurance Commissioner, affected plan sponsors, and affected enrollees at least 60 days before any drug coverage modification takes effect

Modifications requiring advance notice include removing drugs from a formulary, adding prior authorization requirements, imposing or altering quantity limits, adding step-therapy restrictions, and moving drugs to higher cost-sharing tiers (unless a generic alternative exists)

Patients may waive these protections voluntarily but cannot be induced or coerced to do so; any coerced waiver is void

Issuers may offer enrollees the option to receive required notifications by email