Bill > AB339

This bill aims to improve access to and affordability of outpatient prescription drugs for individuals covered by health care service plans and health insurance policies. It prohibits formularies, which are lists of covered drugs, from discouraging enrollment of people with health conditions or reducing benefits for those with specific conditions. For non-grandfathered plans, it sets limits on cost-sharing for covered outpatient prescription drugs, capping copayments and coinsurance at $250 for a 30-day supply, with higher limits for bronze-level plans and high-deductible plans, and limits annual deductibles for outpatient drugs. The bill also mandates coverage for medically necessary prescription drugs, including those not on the formulary, and requires health plans and insurers to have a pharmacy and therapeutics committee responsible for overseeing drug formularies. Additionally, it ensures that individuals can access their prescription drug benefits at in-network retail pharmacies and requires that cost-sharing for these drugs counts towards annual out-of-pocket limits. These provisions apply to plans and policies offered, renewed, or amended on or after January 1, 2017, with some provisions expiring on January 1, 2020.