Bill > H792

This bill requires health insurance carriers and other health plans to provide greater transparency regarding their drug formularies, which are lists of drugs covered by the plan. Starting January 1, 2017, these plans must post their formularies online in an easily searchable format for enrollees and potential enrollees, and update them within 24 hours of any changes. The formularies must detail any restrictions or requirements for specific drugs, such as prior authorization or step therapy (where a cheaper drug must be tried first), and if the plan uses tiers for different drug costs, the tier and co-payment for each drug must be clearly listed. For drugs administered by a provider, plans must disclose all covered drugs and associated costs, either on the formulary or through a toll-free number. Additionally, for drugs subject to coinsurance at an in-network pharmacy, the plan must either state the exact cost-sharing amount or provide a dollar range using a tiered system ($ to $$$$$). Mail-order pharmacy costs must also be disclosed using the same ranges. The bill also mandates a description of how medications are factored into deductibles and out-of-pocket costs. Carriers must make this information available before open enrollment periods and attest to compliance with the insurance commissioner within 30 days of offering or renewing a plan. The Division of Insurance may also develop a standard template for these formularies.