HB 578/HM (BR 1156) - J. Kay
AN ACT relating to health benefit plans which include a tiered formulary for prescription drugs.
Create new sections of Subtitle 17A of KRS Chapter 304 to define terms; require health benefit plans that provide coverage for prescription drugs subject to a tiered formulary to ensure that any copayment or coinsurance applicable to specialty drugs not exceed $100 per month for up to a 30-day supply and that the copayment or coinsurance for specialty tier drugs shall not exceed $200 per month in the aggregate; require an exceptions process for tiered formulary plans that allows an insured to request an exception to the tiered cost-sharing structure, including coverage of a non-preferred drug under the cost sharing, applicable for preferred drugs if the prescribing physician determines that the preferred drug would not be as effective or would have an adverse effect, or both, for the insured, and denial of a cost-sharing exception shall be subject to an external review; prohibit placing all drugs of the same class in a specialty tier; require the commissioner to promulgate administrative regulations to implement this section; provide that nothing in the section requires coverage of any drugs not otherwise required by law, specific utilization management techniques, or ceasing utilization of tiered cost-sharing structure; provide that nothing in the section is to be construed to require a pharmacist to substitute a drug without the written consent of the prescribing physician; provide that the new sections apply to health benefit plans issued, amended, or renewed on or after January 1, 2015.
Mar 4-introduced in House
Mar 5-to Banking & Insurance (H)