Bill > SB5594

This bill aims to reduce prescription drug costs by removing barriers to accessing biosimilar medicines and interchangeable biological products, which are less expensive versions of existing biologic drugs that have been shown to be as safe and effective. Specifically, it modifies existing laws to ensure that health plans have a clear and accessible process for patients and doctors to request exceptions to prescription drug utilization management, which are rules that control which drugs are covered. The bill also requires health plans to disclose their criteria for these management processes and sets timelines for approving or denying exception requests, with a provision that requests are automatically granted if not responded to within the specified timeframes. Furthermore, it clarifies that pharmacists can substitute therapeutically equivalent drugs or interchangeable biological products unless the prescriber explicitly states otherwise, and that such substitutions are permissible if the consumer's out-of-pocket cost is lower. The bill also mandates that qualified health plans offered through the state's health benefit exchange must increase the utilization of generic and biosimilar drugs.