5184-S AMS OBAN KLEI 133
SSB 5184 - S AMD 404
By Senator O'Ban
NOT ADOPTED 03/13/2019
On page 1, beginning on line 10, after "must" strike all material through "year" on line 17 and insert "provide information in the enrollee health plan booklet that clearly describes the pharmacy benefit coverage and the use of nonresident pharmacies to fill certain prescriptions, and includes contact information for receiving more information about the options available for filling prescriptions. The booklet must be available upon enrollment and at the request of the enrollee"
On page 1, beginning on line 18, strike all of subsection (3), and insert "(3) Each enrollee must be provided information by the health carrier or pharmacy benefit manager or its agents clearly describing the rights that the enrollee has available to him or her regarding use of a nonresident pharmacy."
On page 2, beginning on line 1, strike all of subsection (4)
Renumber the remaining subsections consecutively and correct any internal references accordingly.
On page 2, line 7, after "purchase" insert "all of his or her"
| EFFECT: (1) Removes the requirement that health carriers require pharmacy benefit managers to obtain affirmative authorization from an enrollee, prior to filling an enrollee's prescription through a nonresident pharmacy. (2) Requires health carriers to provide information in enrollee health plan booklets that describes the pharmacy benefit coverage and the use of nonresident pharmacies. (3) Removes the requirement that each nonresident pharmacy shipment include a notice to the enrollee clearly describing actions the enrollee can take to terminate use of a nonresident pharmacy. (4) Requires health carriers or pharmacy benefit managers to provide information to enrollees describing the rights that the enrollee has available to them regarding use of a nonresident pharmacy. (5) Removes the requirement that health plans include information in the enrollee health plan booklet explaining the requirement that the enrollee's affirmative authorization be attained prior to filling a prescription through a nonresident pharmacy. (6) Prohibits a health plan from, as a condition of payment or reimbursement, requiring an enrollee to purchase all of their pharmacy services through a nonresident pharmacy, as opposed to purchasing any pharmacy services through a nonresident pharmacy.
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