THE SENATE

S.B. NO.

301

TWENTY-EIGHTH LEGISLATURE, 2015

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to health.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

     "§431:10A-    Formulary; accessibility requirements.  (a)  Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall:

     (1)  Post the formulary for the policy on the insurer's website in a manner that is accessible and searchable by insureds, potential insureds, and providers;

     (2)  Update the formulary on the insurer's website no later than twenty-four hours after making a change to the formulary; and

     (3)  On any published formulary, include, at minimum, the following:

         (A)  Any utilization management edits, including prior authorization, step therapy edits, quantity limits, or other requirements for each specific drug included in the formulary; and

         (B)  For each drug included in the formulary and subject to coinsurance, the range of cost sharing for a potential insured if the drug is purchased in person at an in-network pharmacy as follows:

              (i)  Under $100:  $          ;

             (ii)  $100 to $250:  $          ;

            (iii)  $251 to $500:  $          ; and

             (iv)  Over $500:  $          .

     If the insurer allows the option for mail order pharmacy, the insurer shall separately list the range of cost-sharing for a potential insured if the potential insured purchases the drug through a mail order facility utilizing the same ranges as provided in this subsection.

     (b)  Each insurer posting the formulary pursuant to subsection (a) shall use a template that:

     (1)  Is standardized across all individual and group accident and health or sickness insurance policies offered by the insurer;

     (2)  Uses the United States Pharmacopeia classification system;

     (3)  Organizes drugs by therapeutic class, listing drugs alphabetically; and

     (4)  Provides a separate list for drugs used to treat a serious illness covered under the policy's medical benefit.

     (c)  Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall make available to current and potential insureds the information mandated pursuant to subsections (a) and (b).  The information shall be available prior to the beginning of the open enrollment period and shall be done via a public website and through a toll-free number that is posted on the insurer's website.

     (d)  Each insurer subject to this section shall, no later than thirty days after the offer or renewal date, attest to the insurance commissioner that the insurer has satisfied the requirements of this section.

     (e)  The insurance commissioner may adopt rules to implement this section.

     (f)  For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy including drugs covered under the policy's pharmacy benefit and medical benefit as defined by the insurance commissioner."

     SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

     "§432:1-    Formulary; accessibility requirements.  (a)  Each mutual benefit society that issues or renews a hospital and medical service plan on or after January 1, 2017, shall:

     (1)  Post the formulary for the plan on the mutual benefit society's website in a manner that is accessible and searchable by members, potential members, and providers;

     (2)  Update the formulary for the plan on the mutual benefit society's website no later than twenty-four hours after making a change to the formulary; and

     (3)  On any published formulary for the plan, include, at minimum, the following:

         (A)  Any utilization management edits, including prior authorization, step therapy edits, quantity limits, or other requirements for each specific drug included in the formulary; and

         (B)  For each drug included in the formulary and subject to coinsurance, the range of cost sharing for a potential member if the drug is purchased in person at an in-network pharmacy as follows:

              (i)  Under $100:  $          ;

             (ii)  $100 to $250:  $          ;

            (iii)  $251 to $500:  $          ; and

             (iv)  Over $500:  $          .

     If the mutual benefit society allows the option for mail order pharmacy, the mutual benefit society shall separately list the range of cost-sharing for a potential member if the potential member purchases the drug through a mail order facility utilizing the same ranges as provided in this subsection.

     (b)  Each mutual benefit society posting the formulary pursuant to subsection (a) shall use a template that:

     (1)  Is standardized across all hospital and medical service plans offered by the mutual benefit society;

     (2)  Uses the United States Pharmacopeia classification system;

     (3)  Organizes drugs by therapeutic class, listing drugs alphabetically; and

     (4)  Provides a separate list for drugs used to treat a serious illness covered under the plan's medical benefit.

     (c)  Each mutual benefit society offering or renewing a hospital and medical service plan on or after January 1, 2017, shall make available to current and potential members the information mandated pursuant to subsections (a) and (b).  The information shall be available prior to the beginning of the open enrollment period and shall be done via a public website and through a toll-free number that is posted on the mutual benefit society's website.

     (d)  Each mutual benefit society subject to this section shall, no later than thirty days after the offer or renewal date, attest to the insurance commissioner that the mutual benefit society has satisfied the requirements of this section.

     (e)  The insurance commissioner may adopt rules to implement this section.

     (f)  For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a plan, including drugs covered under the plan's pharmacy benefit and medical benefit as defined by the insurance commissioner."

     SECTION 3.  Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

     "§432D-23  Required provisions and benefits.  Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, [431:10A-122, and 431:10A-116.2,] 431:10A‑   , and chapter 431M."

     SECTION 4.  New statutory material is underscored.


     SECTION 5.  This Act shall take effect on July 1, 2015.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Formulary; Posting Requirements; Insurers; Health Plan

 

Description:

Requires entities that offer or renew health plans on or after January 1, 2017, to make available a complete and updated formulary to enrollees, potential enrollees, and providers.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.