Bill > H969

This bill aims to empower health care consumers by requiring health insurance plans to provide more transparency and information about their prescription drug formularies. The key provisions of the bill include: 1. Requiring plans to provide clear notice to enrollees about whether the plan uses a formulary, how the formulary is determined, and how often it is reviewed. 2. Mandating plans to post their formularies on their websites in an accessible and searchable format, and update them within 72 hours of any changes. 3. Obligating plans to use a standard template developed by the Division of Insurance to display their formularies. 4. Compelling plans to disclose specific details about their formularies, such as any prior authorization, step therapy, or utilization management requirements for each drug, the tier structure and corresponding copayments, and the dollar cost-sharing for drugs covered under the medical benefit. 5. Directing plans to provide a range of cost-sharing amounts for each drug subject to coinsurance, both for in-network pharmacies and mail-order options. 6. Requiring plans to describe how medications will be included or excluded from deductibles and any out-of-pocket costs that may not apply to the deductible. The overall goal of the bill is to improve transparency and empower consumers to make more informed decisions about their health care coverage, particularly with respect to prescription drug benefits.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/191/H969