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11 08, 2023

SB 513

requires each health benefit plan to provide coverage for biomarker testing and to provide evidence of such coverage. The document showing the plan covers biomarker testing shall include labeled indications for tests that are approved or cleared by the United States Food and Drug Administration (FDA), tests for a drug that is approved by the FDA, precautions on FDA approved drug labels, national coverage determinations or Medicare administrative contractor local coverage determinations, and nationally recognized clinical practice guidelines and consensus statements. The insured shall also have access to a clear, readily available, and convenient [...]

SB 513
11 08, 2023

SB 242 (see companion bill HB 2330)

Long-term care; eliminating certificate of need requirements for long-term care facilities and psychiatric and chemical dependency facilities.

SB 242 (see companion bill HB 2330)
11 08, 2023

SB 143

provides that any high deductible health plan, as defined in current law, shall allow an insured member to set aside funds on a tax-free basis, up to the contribution limit provided in Section 223 of the Internal Revenue Code, to pay for out-of-pocket medical expenses.

SB 143
11 08, 2023

SB 549

requires the Patient’s Right to Pharmacy Choice Commission conduct hearings in accordance with the Administrative Procedures Act. Requires each health insurer payor that utilizes the services of a pharmacist benefits manager (PBM) and each PBM to electronically submit a network adequacy audit and any fees assessed to the Insurance Department on a semiannual basis. Each calendar day in a single 5-digit postal code where a PBM or insurer has failed to comply with these provisions shall be deemed an instance of violation. The measure also provides that a PBM contract shall not be amended [...]

SB 549
11 08, 2023

SB 145

prohibits insurers from modifying an insured’s coverage of a prescription drug if drug had been previously preauthorized for coverage, the insured already received the drug, and a practitioner continues to prescribe the drug. If the Food and Drug Administration (FDA) has issued a statement calling into question the clinical safety of the drug or if the FDA has been notified of a manufacturing discontinuance or potential discontinuance of the drug, the measure does not prohibit modification of coverage. Any insurer that violates the provisions of this measure shall be subject to a civil penalty [...]

SB 145
11 08, 2023

SB 144

directs the Insurance Department to compile list of prescription drugs that the Department determines to be essential for treating diabetes. The list will include price increases for said drugs. Any manufacturer of a drug that appears on the list must provide information outlined in the measure to the Department, including the drug’s price, administrative expenditures associated with the drug, profit from the drug, financial assistance received relating to the drug, wholesale acquisition cost of the drug, a history of price increases relating to the drug, the aggregate amount of rebates received relating to the [...]

SB 144
11 08, 2023

SB 142

lowers the price cap on a 30-day supply of insulin from $30.00 to $25.00. The measure also provides that if the price of an FDA-approved diabetes equipment or supply product cost exceeds $35.00, the health benefit plan shall cap the total amount that an insured is required to pay for a 30-day supply at an amount not to exceed $35.00. The measure provides that, if the cost of the 30-day supply, ninety-day supply, or diabetes equipment or supply product is less than the applicable copayment cap, a health benefit plan shall reduce the cost-sharing [...]

SB 142
11 08, 2023

HB 1843

restores previously stricken language in Section 3, allowing the Insurance Commissioner to censure, suspend, revoke or refuse to issue or renew a license of or levy a civil penalty against any person licensed under the insurance laws of this state for any violation of the Patient's Right to Pharmacy Choice Act. The amendment also allows for the Attorney General to recommend that a pharmacy benefits manager (PBM) be censured if they are found in violation of the measure, and requires that the Insurance Commissioner take the recommended action.

HB 1843
11 08, 2023

SB 879

provides that pharmacy benefits manager (PBM) contracts shall not prohibit from or penalize for a pharmacy or pharmacist disclosing to an individual information regarding the existence and clinical efficacy of a generic equivalent nor shall it prohibit or penalize a pharmacy or pharmacist selling a therapeutically equivalent drug that would be less expensive to the enrollee. Additionally, PBM’s are required to publish on their website the health plan formulary and timely notification of formulary changes and product exclusions for each of their contracts. The measure directs every PBM to also provide the Insurance Department [...]

SB 879
11 08, 2023

SB 768

requires any pharmacy benefits manager (PBM) to provide the Insurance Department with the minimum and maximum wholesale acquisition cost (WAC) of a drug, the minimum and maximum WAC for each indicated drug and drug group for which the PBM has negotiated directly with the manufacturer, the number of WAC units that were negotiated in the current calendar year, the projected number of WAC units in the current calendar year, rebates and discounts negotiated, projected rebates and discounts, total discounts, projected total discounts, total net income, and projected total net income. Manufacturers shall be required [...]

SB 768