Bill > SB1102

This bill introduces new regulations for pharmacy benefit managers (PBMs) to protect insured individuals' prescription drug coverage. The legislation establishes two key provisions: first, a PBM cannot limit or exclude coverage of a prescription drug for a covered individual who was previously approved for that medication and remains insured, with coverage continuing through the end of the health plan year. Second, the bill mandates that PBMs provide at least 60 days' written notice before making any formulary changes that would limit drug coverage, and must include a clear process for healthcare providers to request continued use of a non-formulary drug. The bill also creates a detailed formulary exception process, requiring PBMs to respond to exception requests within 72 hours (or 24 hours in urgent cases) and consider factors like the patient's previous therapeutic outcomes and potential medical risks when evaluating these requests. Healthcare providers can request continued use of a non-formulary drug if the patient has experienced a positive outcome, the alternative drug might cause adverse interactions, or the formulary drug is not medically appropriate. The legislation applies specifically to PBMs subject to certain state regulations and will take effect for contracts entered into or renewed after December 31, 2025, aimed at providing more transparency and patient protection in prescription drug coverage.

Health and Social Services

https://apps.azleg.gov/BillStatus/BillOverview/81931