HB1745: INS-PRESCRIPTION DRUG BENEFITS

Legislative Summary

Amends the Managed Care Reform and Patient Rights Act. In provisions concerning individual health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall ensure that at least 10% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall ensure that at least 25% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit. In provisions concerning group health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall offer at least one group health plan in each applicable service area that applies a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall offer at least 2 group health plans in each applicable service area that apply a flat-dollar copayment structure to the entire drug benefit. Provides that the flat-dollar copayment structure for prescription drugs must be applied pre-deductible and be reasonably graduated and proportionately related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs. Requires the health insurance carriers to clearly and appropriately name the plans to aid in individual or group plan selection. Requires the health insurance carriers to market the plans in the same manner as their other plans. Requires the Department of Insurance to adopt rules necessary to implement and enforce the provisions. Effective January 1, 2023.