Bill > S542

This bill aims to make out-of-pocket expenses for prescription drug coverage more affordable. It proposes to limit the cost-sharing (such as copayments, deductibles, or coinsurance) for a covered prescription drug to no more than $100 per 30-day supply. Additionally, it prohibits health plans from placing all drugs in a given class on the highest cost-sharing tier in a tiered formulary. The bill applies these provisions before the deductible is met and after the minimum deductible amounts required for high-deductible health plans are met. It also allows enrollees to request an exception to the formulary if the prescribing physician determines that the formulary drug would not be as effective or would have adverse effects. The bill does not require health plans to provide coverage for additional drugs or implement specific utilization management techniques, nor does it require them to cease the use of tiered cost-sharing structures.

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https://malegislature.gov/Bills/190/S542