HB 1481 - AS INTRODUCED
2000 SESSION
HOUSE BILL 1481
AN ACT requiring managed care organizations to offer prescription drug plans.
SPONSORS: Rep. Lynott, Ches 11
This bill requires managed care plans governed by RSA 420-J to offer their enrollees a prescription drug plan.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
00-2220
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand
AN ACT requiring managed care organizations to offer prescription drug plans.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Prescription Drug Plans Required. Amend RSA 420-J:7-b to read as follows:
420-J:7-b Prescription Drugs.
I.(a) Every health benefit plan [that provides prescription drug benefits] is required to provide prospective enrollees a prescription drug benefit plan, and shall annually provide to covered persons, a description of the prescription drug benefit plan. Among the specific items that shall be included in the description are:
(1) The procedure a covered person must follow to obtain drugs and medications that are subject to a plan list or plan formulary.
(2) A description of the drug formulary and the plan's exception process.
(3) A description of the extent to which a covered person will be reimbursed for the cost of a drug that is not on a plan list or formulary.
(b) Health carriers shall provide upon request additional information to covered persons related to specific drugs that are not on the formulary.
II. Every health benefit plan [that provides prescription drug benefits] shall maintain an expeditious exception process, not to exceed 48 hours, by which covered persons may obtain coverage for a medically necessary nonformulary prescription drug. The exception process shall begin when the prescribing provider has provided the health benefit plan with the clinical rationale for the exception.
III. Every health plan [that provides prescription drug benefits] shall notify covered persons of changes to the plan list or plan formulary, provide an explanation of the exception process by which a covered person can access nonformulary medically necessary prescription drugs, and provide a toll-free telephone number through which a covered person can request additional information. Upon notification to covered persons, the health benefit plan shall allow at least 45 days before implementation of any formulary change; provided, however, that advance notice shall not be required if the federal food and drug administration has determined that a prescription drug on the health benefit plan's formulary is unsafe.
IV. Every health benefit plan [that provides prescription drug benefits] shall maintain, as part of its records, all of the following information, which shall be made available to the commissioner upon request: the complete drug formulary or formularies of the plan, if the plan maintains a formulary, including a list of prescription drugs on the formulary of the plan by major therapeutic category with an indication of whether any drugs are preferred over the other drugs.
2 Effective Date. This act shall take effect 60 days after its passage.