Bill > S519

This bill mandates that health insurance providers, including those offering policies, contracts, agreements, plans, certificates of insurance, hospital service plans, medical service agreements, and health maintenance contracts, must make their drug formularies publicly accessible and searchable on their websites by January 1, 2017. A formulary is defined as the complete list of drugs preferred for use and eligible for coverage under a health plan. These formularies must be updated within 24 hours of any changes and must clearly indicate any utilization management edits, such as prior authorization or step therapy requirements, for each drug. Additionally, for drugs subject to coinsurance, the formulary must display the range of potential out-of-pocket costs for enrollees, categorized by dollar amounts, for both in-person and mail-order pharmacy purchases. The bill also requires formularies to use a standardized template, organized by therapeutic class and using the United States Pharmacopeia classification system, with a separate section for drugs treating serious illnesses. Health plans must provide this information to current and potential enrollees before open enrollment periods via their website and a toll-free number, and carriers must attest to the insurance commissioner that they are compliant with these requirements within 30 days of offering or renewing a plan. The Commissioner of the Division of Insurance is empowered to create rules to implement these provisions.