Bill > H1155

This bill aims to enhance transparency and consumer understanding of health insurance prescription drug coverage by requiring health insurance plans, including hospital service plans, medical service agreements, health maintenance contracts, and state employee group insurance, to provide detailed formulary information to enrollees and potential enrollees starting January 1, 2018. The bill mandates that plans disclose whether they use a formulary (a list of covered prescription drugs), explain how drugs are selected, and post their formularies online in an accessible, searchable format. Plans must update their formularies within 72 hours of any changes and use a standard template developed by the Division of Insurance. The formulary must include comprehensive details such as prior authorization requirements, drug tiers with corresponding co-payments, specific cost-sharing information for drugs administered by providers, and a range of potential out-of-pocket costs for prescription drugs (categorized in dollar ranges from under $100 to over $1,000). Additionally, plans must provide information about mail-order pharmacy options, describe how medications are included or excluded from deductibles, and offer clear explanations of cost-sharing for each drug. These requirements are designed to help consumers better understand their prescription drug coverage and make more informed healthcare decisions.

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https://malegislature.gov/Bills/194/H1155