THE SENATE

S.B. NO.

2494

TWENTY-FIFTH LEGISLATURE, 2010

S.D. 2

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO INSURANCE.

 

 

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

 


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

"431:10A‑   Prescription drug coverage; medically necessary; continuation of coverage. (a) If an insured's physician determines within six months of a change in insurer by the insured or a change in an insurer's prescription drug formulary or coverage policy, that it is in the best interest of the insured to continue to have coverage for a certain prescription medication that the physician determines to be life-saving, any insurer that issues a policy that offers coverage for prescription drug benefits shall continue coverage for that prescription medication under any policy entered into by the insured and the insurer on or after July 1, 2010.

A medication shall be deemed life saving if it is necessary to treat a chronic disease or illness, maintain the patient's life, or preserve the patient's health or quality of life to the extent that the patient would be unable to continue to perform necessary life activities such as work, school, self-care, or independent living to the same degree without the medication as with it. Life-saving medication shall include but shall not be limited to:

(1) Anticancer drugs, including both oral and intravenous chemotherapy;

(2) Intravenous immune globulin therapy, also known as IVIG; and

(3) Pediatric prescriptions for children with chronic diseases or conditions.

(b) For the purposes of this section:

"Coverage" means the benefits, costs, and requirements for patient access to medical products and services as enumerated in the written explanation of benefits document issued by the health carrier.

"Prescription drug benefits" means the prescription drug benefits as defined in the explanation of benefits document issued by the health insurance carrier that describes the cost, cost-sharing, and available medications, as well as any utilization management requirements that patients must meet in order to access the prescribed drug."

SECTION 2. Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to part II to be appropriately designated and to read as follows:

"431:10A‑   Prescription drug coverage; medically necessary; continuation of coverage. If an insured's physician determines within six months of a change in insurer by the insured or a change in an insurer's prescription drug formulary or coverage policy, that it is in the best interest of the insured to continue to have coverage for a certain prescription medication that the physician determines to be life-saving, any insurer that issues a policy that offers coverage for prescription drug benefits shall continue coverage for that prescription medication under any policy entered into by the insured and the insurer on or after July 1, 2010.

A medication shall be deemed life saving if it is necessary to treat a chronic disease or illness, maintain the patient's life, or preserve the patient's health or quality of life to the extent that the patient would be unable to continue to perform necessary life activities such as work, school, self-care, or independent living to the same degree without the medication as with it. Life-saving medication shall include but shall not be limited to:

(1) Anticancer drugs, including both oral and intravenous chemotherapy;

(2) Intravenous immune globulin therapy, also known as IVIG; and

(3) Pediatric prescriptions for children with chronic diseases or conditions.

(b) For the purposes of this section:

"Coverage" means the benefits, costs, and requirements for patient access to medical products and services as enumerated in the written explanation of benefits document issued by the health carrier.

"Prescription drug benefits" means the prescription drug benefits as defined in the explanation of benefits document issued by the health insurance carrier that describes the cost, cost-sharing, and available medications, as well as any utilization management requirements that patients must meet in order to access the prescribed drug."

SECTION 3. Chapter 432, article I, Hawaii Revised Statutes, is amended by adding a new section to part VI to be appropriately designated and to read as follows:

"432:1‑   Prescription drug coverage; medically necessary; continuation of coverage. If a member's physician determines within six months of a change in insurer by the member or a change in a mutual benefit society's prescription drug formulary or coverage policy, that it is in the best interest of the member to continue to have coverage for a certain prescription medication that the physician determines to be life-saving, any mutual benefit society that issues a policy that offers coverage for prescription drug benefits shall continue coverage for that prescription medication under any policy entered into by the member and the mutual benefit society on or after July 1, 2010.

A medication shall be deemed life saving if it is necessary to treat a chronic disease or illness, maintain the member's life, or preserve the member's health or quality of life to the extent that the member would be unable to continue to perform necessary life activities such as work, school, self-care, or independent living to the same degree without the medication as with it. Life-saving medication shall include but shall not be limited to:

(1) Anticancer drugs, including both oral and intravenous chemotherapy;

(2) Intravenous immune globulin therapy, also known as IVIG; and

(3) Pediatric prescriptions for children with chronic diseases or conditions.

(b) For the purposes of this section:

"Coverage" means the benefits, costs, and requirements for patient access to medical products and services as enumerated in the written explanation of benefits document issued by the health carrier.

"Prescription drug benefits" means the prescription drug benefits as defined in the explanation of benefits document issued by the health insurance carrier that describes the cost, cost-sharing, and available medications, as well as any utilization management requirements that patients must meet in order to access the prescribed drug."

SECTION 4. Chapter 432, article II, Hawaii Revised Statutes, is amended by adding a new section to part IV to be appropriately designated and to read as follows:

"432:2‑   Prescription drug coverage; medically necessary; continuation of coverage. If a member's physician determines within six months of a change in insurer by the member or a change in an insurer's prescription drug formulary or coverage policy, that it is in the best interest of the insured to continue to have coverage for a certain prescription medication that the physician determines to be life-saving, any fraternal benefit society that issues a policy that offers coverage for prescription drug benefits shall continue coverage for that prescription medication under any policy entered into by the member and fraternal benefit society on or after July 1, 2010.

A medication shall be deemed life saving if it is necessary to treat a chronic disease or illness, maintain the member's life, or preserve the member's health or quality of life to the extent that the member would be unable to continue to perform necessary life activities such as work, school, self-care, or independent living to the same degree without the medication as with it. Life-saving medication shall include but shall not be limited to:

(1) Anticancer drugs, including both oral and intravenous chemotherapy;

(2) Intravenous immune globulin therapy, also known as IVIG; and

(3) Pediatric prescriptions for children with chronic diseases or conditions.

(b) For the purposes of this section:

"Coverage" means the benefits, costs, and requirements for patient access to medical products and services as enumerated in the written explanation of benefits document issued by the health carrier.

"Prescription drug benefits" means the prescription drug benefits as defined in the explanation of benefits document issued by the health insurance carrier that describes the cost, cost-sharing, and available medications, as well as any utilization management requirements that patients must meet in order to access the prescribed drug."

SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432D‑   Prescription drug coverage; medically necessary; continuation of coverage. If a member's physician determines within six months of a change in insurer by the member or a change in an health maintenance organization's prescription drug formulary or coverage policy, that it is in the best interest of the member to continue to have coverage for a certain prescription medication that the physician determines to be life-saving, any health maintenance organization that issues a policy that offers coverage for prescription drug benefits shall continue coverage for that prescription medication under any policy entered into by the member and the health maintenance organization on or after July 1, 2010.

A medication shall be deemed life saving if it is necessary to treat a chronic disease or illness, maintain the member's life, or preserve the member's health or quality of life to the extent that the member would be unable to continue to perform necessary life activities such as work, school, self-care, or independent living to the same degree without the medication as with it. Life-saving medication shall include but shall not be limited to:

(1) Anticancer drugs, including both oral and intravenous chemotherapy;

(2) Intravenous immune globulin therapy, also known as IVIG; and

(3) Pediatric prescriptions for children with chronic diseases or conditions.

(b) For the purposes of this section:

"Coverage" means the benefits, costs, and requirements for patient access to medical products and services as enumerated in the written explanation of benefits document issued by the health carrier.

"Prescription drug benefits" means the prescription drug benefits as defined in the explanation of benefits document issued by the health insurance carrier that describes the cost, cost-sharing, and available medications, as well as any utilization management requirements that patients must meet in order to access the prescribed drug."

SECTION 6. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 7. New statutory material is underscored.

SECTION 8. This Act shall take effect on July 1, 2050.

 



 

Report Title:

Health Insurance; Drug Coverage

 

Description:

Requires health insurers and like entities to offer continued coverage of specific prescription medications where an individual's physician determines that continued coverage is in the best interest of the patient after changing insurance carriers. Effective 7/1/50. (SD2)

 

 

 

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