Download User Guide

428 results returned.
Page   of  27

215 Ill. Comp. Stat. § 134/45.1. Medical exceptions procedures required: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2014
Notwithstanding any other provision of law, on or after the effective date of this amendatory Act of the 99th General Assembly, every insurer licensed in this State to sell a policy of group or individual …
Download
215 Ill. Comp. Stat. § 134/45.2. Prior authorization form; prescription benefits: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2014
A health insurer that provides prescription drug benefits must, within 72 hours after receipt of a paper or electronic prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization. …
Download
215 Ill. Comp. Stat. § 5/370c. Mental and emotional disorders: Accident and Health Insurance – Illinois
Status: Enacted     Year Enacted: 1977
Plans shall shall provide coverage based upon medical necessity for the treatment of a mental, emotional, nervous, or substance use disorder or condition in parity with physical treatments. Plans shall not impose additional prior authorization …
Download
215 Ill. Comp. Stat. §§ 180/1 through 180/42: Health Carrier External Review Act – Illinois
Status: Enacted     Year Enacted: 2010
The Health Carrier External Review Act’s purpose is to provide uniform standards for the establishment and maintenance of external review procedures. Statutes set out timeline and process for a standard review.
Download
305 Ill. Comp. Stat. § 5/5-30.3. Empowering meaningful patient choice in Medicaid Managed Care: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 2016
Each medicaid managed care entity shall have an updated provider directory. Medicaid Managed Care Entities shall publish on their respective websites a formulary for each plan offered and make the formularies easily understandable and publicly …
Download
40 Pa. Stat. and Pa. Cons. Stat. §§ 4501 through 4503, 4531 through 4535, 4551 through 4562: Pharmacy Audit Integrity and Transparency Act – Pennsylvania
Status: Enacted     Year Enacted: 2016
Governs PBM cost transparency requirements.
Download
5 Ill. Comp. Stat. § 375/6.4. Prescription drugs; cancer treatment: State Employees Group Insurance Act of 1971 – Illinois
Status: Enacted     Year Enacted: 1993
If the program of health benefits provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer, it may not exclude coverage of any drug …
Download
63 Pa. Cons. Stat. § 390-8. Unlawful acts: Pharmacy Acts – Pennsylvania
Status: Enacted     Year Enacted: 1961
It shall be unlawful for any pharmacist to dispense an emergency prescription, unless the pharmacist does the specified. For example, the pharmacist must first attempt to obtain an authorization from the authorized prescriber and cannot …
Download
A 02843 – New York
Introduced: 2019    Status: Inactive / Dead    
Requires Medicaid managed care, and Child Health Plus plans to adopt the procedural protections of the Preferred Drug Program, including “prescriber prevails,” for all drugs.

A 02969 (see companion bill S 02849) – New York
Introduced: 2019    Status: Inactive / Dead    
AN ACT to amend the insurance law and the public health law, in relation to prescription drug formulary changes during a contract year to allow formulary changes mid-year if a generic equivalent is released.

A 03038 (see companion bill S 02847) – New York
Introduced: 2019    Status: Inactive / Dead    
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; amends provisions relating to prescription drug formulary changes and pre-authorization for certain health care services.

A 04521 – New York
Introduced: 2019    Status: Inactive / Dead    
Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to …

A 05724 – New York
Introduced: 2019    Status: Inactive / Dead    
Instructs the superintendent of insurance to deny policies imposing drug tiers based on expense or disease category and charges a cost-sharing percentage for prescription medication.

A 1378 (see companion bill S 3668) – New York
Introduced: 2017    Status: Inactive / Dead    
Enacts the “comprehensive contraception coverage act” to provide insurance coverage for FDA-approved contraceptive drugs, devices and products

A 1946 – New Jersey
Introduced: 2018    Status: Inactive / Dead    
ALLOWS PHYSICIANS TO JOINTLY NEGOTIATE WITH CARRIERS OVER CONTRACTUAL TERMS AND CONDITIONS. The bill permits two or more independent physicians who are practicing in the geographic service area of a carrier to jointly negotiate with the …

A 2001 – New Jersey
Introduced: 2020    Status: Inactive / Dead    
Allows physicians to jointly negotiate with carriers over contractual terms and conditions. This bill provides physicians with the right to engage in joint negotiations over the terms and conditions of their contracts with health insurance …

428 results returned.
Page   of  27

© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.