Ky. Rev. Stat. § 18A.225. Health care insurance coverage; requirements of prospective carriers; analysis of carrier coverage data; agency’s termination of participation; provision of amount of employer contribution; lapse of excess flexible spending account funds; appeal of formulary change; retiree’s participation; mail order drug option coverage; hearing aid coverage for minors; coverage for diagnosis and treatment of autism spectrum disorders; amino acid-based elemental formula coverage; access to certain services in contiguous counties; study of bid variation; regional rating bid scenario; optometric coverage; nondiscrimination against provider in geographic coverage area; standards for provider participation; utilization review; payment of claims; uniform health insurance claim forms; emergency medical care; administrative regulations (Effective July 1, 2019): Health Coverage – Kentucky
Status: Enacted Year Enacted: 1982
The Personnel Cabinet is encouraged to study whether it is fair and reasonable and in the best interests of the state group to allow any carrier bidding to offer health care coverage under this section …
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Ky. Rev. Stat. § 18A.2254. Self-insured plan for public employees; contract for third-party administrator; formulary change; health reimbursement account, health flexible spending account, or health savings account; public employee health insurance trust fund; annual audit; quarterly status reports: Health Coverage – Kentucky
Status: Enacted Year Enacted: 2006
The plan year handbook for self-insured plans shall contain the premiums, employee contributions, employer contributions, and a summary of benefits, copays, coinsurance, and deductibles for each plan.
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Ky. Rev. Stat. § 304.17A-535. Drug utilization waiver program; limitations on generic substitution; application to drug formulary: Managed Care Plans – Kentucky
Status: Enacted Year Enacted: 1998
A managed care plan shall include a drug utilization review program. A managed care plan that restricts pharmacy benefits to a drug formulary shall have an exceptions policy through which the managed care plan may …
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Ky. Rev. Stat. § 304.17A-540. Disclosure of limitations on coverage; denial letter: Managed Care Plans – Kentucky
Status: Enacted Year Enacted: 1998
Any insurer that limits coverage for any treatment, procedure, a drug, or device shall define the limitations and fully disclose those limits in the health insurance policy or certificate coverage.
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Ky. Rev. Stat. § 304.17C-030. Disclosure: Limited Health Service Benefit Plans – Kentucky
Status: Enacted Year Enacted: 2002
An insurer shall disclose in writing to an insured or enrollee the terms and conditions of its limited health service benefit plan, such as prior authorization, and shall promptly provide the covered person and enrollee …
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La. Rev. Stat. Ann. § 22:1657. Pharmacy benefit managers: Third-Party Administrators – Louisiana
Status: Enacted Year Enacted: 2008
A pharmacy benefit manager shall be deemed to be a third-party administrator for purposes of this Part. No pharmacy benefit manager or other entity that administers prescription drug benefits in Louisiana shall prohibit, by contract, a …
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LB 337 – Nebraska
Introduced: 2021 Status: Enacted
Adopt the Step-Therapy Reform Act: When coverage of a prescription drug for the treatment or any medical condition is restricted for use by a health carrier or utilization review organization through the use of a …
LD 1009 – Maine
Introduced: 2019 Status: Enacted
This bill requires health insurance carriers to establish a process for prescription drug step therapy exceptions.
LD 1268 – Maine
Introduced: 2021 Status: Enacted
An Act To Provide Greater Access to Treatment for Serious Mental Illness by Restricting Prescription Drug Utilization Management by an Insurance Carrier
LD 1428 – Maine
Introduced: 2023 Status: Inactive / Dead
This bill prohibits prior authorization requirements and step therapy protocols under the MaineCare program for prescription drugs used to assess or treat serious mental illness. The implementation of the prohibition must be consistent with the …
LD 1504 – Maine
Introduced: 2019 Status: Enacted
This bill replaces the current registration requirement for pharmacy benefits managers doing business in this State with a licensing requirement beginning January 1, 2020. The bill imposes the following requirements on a carrier that provides …
LD 1706 – Maine
Introduced: 2021 Status: Inactive / Dead
An Act To Require Appropriate Coverage of and Cost-sharing for Generic Drugs and Biosimilars
LD 1730 – Maine
Introduced: 2021 Status: Enacted
An Act To Correct Inconsistencies, Conflicts and Errors in the Laws of Maine
LD 636 – Maine
Introduced: 2015 Status: Enacted
AN ACT TO PROVIDE CONSUMERS OF HEALTH CARE WITH INFORMATION REGARDING HEALTH CARE COSTS: requires carriers that offer health plans in Maine to provide enrollees and prospective enrollees with information, on a publicly accessible website, …
LD 705 – Maine
Introduced: 2019 Status: Enacted
This bill amends the prior authorization process for health insurance carriers. It reduces the time frame for a carrier’s response to a prior authorization request and it exempts medication-assisted treatment for opioid use disorder from …
LD 706 – Maine
Introduced: 2019 Status: Inactive / Dead
This bill provides for reimbursement under the MaineCare program for medical nutritional therapy and prescription drug therapy.