Bill > H1125

This bill addresses "non-medical switching" in health benefit plans, which occurs when a health insurance carrier makes restrictive changes to its prescription drug formulary that force patients to switch from their current medication to a less expensive alternative, even if they are medically stable on their existing prescription. The bill requires health carriers to maintain coverage for a patient's current prescription drug if: the drug was previously approved, prescribed within the last six months, and the patient remains enrolled in the health plan. The legislation establishes a detailed process for requesting coverage exemptions, mandating that health carriers respond to exemption requests within 72 hours (or 24 hours in urgent cases), and provides patients and their healthcare professionals with a clear pathway to appeal coverage denials. If a health plan is discontinued, the bill ensures that patients can maintain their current prescription coverage when enrolling in a comparable plan from the same carrier. The bill applies to health benefit plans delivered, issued, or renewed in the state on or after January 1, 2026, and covers multiple types of health insurance plans, including those governed by Chapters 175, 176A, 176B, and 176G. The legislation aims to protect patients from abrupt and potentially harmful medication changes driven solely by cost considerations, giving priority to medical stability and continuity of care.

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https://malegislature.gov/Bills/194/H1125