Washington State House of Representatives Office of Program Research | BILL ANALYSIS |
Health Care & Wellness Committee |
HB 2310
This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent. |
Brief Description: Concerning prescription drug insurance continuity of care.
Sponsors: Representatives Jinkins, Slatter, Harris, DeBolt, Sullivan, Riccelli, Macri, Tharinger, Robinson, Dolan, Valdez, Chapman, Appleton, Doglio and Young.
Brief Summary of Bill |
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Hearing Date: 1/12/18
Staff: Jim Morishima (786-7191).
Background:
A health plan offering coverage to individuals or small groups is required, under the federal Patient Protection and Affordable Care Act (PPACA), to cover 10 categories of essential health benefits, one of which is prescription drugs. To comply with the PPACA's prescription drug coverage requirement, an issuer must cover prescription drugs in a manner substantially equal to a benchmark plan selected by the state. The issuer's formulary is part of the prescription drug category and must be substantially equal to the formulary in the benchmark plan. An issuer must file its formulary quarterly with the Office of the Insurance Commissioner.
Summary of Bill:
For plans issued or renewed on or after January 1, 2019, an issuer may not, outside of an open enrollment period, deny continued coverage or increase the copayment or coinsurance amount for a prescription drug to a medically stable enrollee if:
the drug had previously been covered by the plan for the enrollee's medical condition in the current plan year;
a participating provider continues to prescribe the drug for the enrollee's medical condition and the drug is a maintenance medication or for the treatment of a chronic condition;
the drug is appropriately prescribed and is considered safe and effective for treating the enrollee's medical condition; and
the enrollee continues to be enrolled in the plan.
The issuer may continue to:
require generic substitution during the plan year;
add new drugs to its formulary during the plan year if the changed formulary applies only to new prescriptions; and
remove drugs from its formulary because of patient safety concerns, drug recall, or removal from the market.
A participating prescriber may prescribe a different drug covered by the plan if it is medically appropriate for the enrollee.
Appropriation: None.
Fiscal Note: Requested on January 4, 2018.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.