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REFERENCE TITLE: health insurance; formulary; disclosure |
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State of Arizona Senate Fifty-second Legislature First Regular Session 2015
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SB 1420 |
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Introduced by Senator Barto
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AN ACT
Amending Title 20, chapter 2, article 1, Arizona Revised Statutes, by adding section 20‑241; relating to health insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 2, article 1, Arizona Revised Statutes, is amended by adding section 20-241, to read:
20-241. Health insurers; formularies; posting; rules; definitions
A. A health insurer offering or renewing a health plan on or after January 1, 2017 shall:
1. Post the formulary for the health plan on the health insurer's website in a manner that is accessible and searchable by the enrollees, potential enrollees and providers.
2. Update the formulary posted pursuant to paragraph 1 of this subsection no later than twenty‑four hours after making a change to the formulary.
3. Include on any published formulary for the health plan, including the formulary posted pursuant to paragraph 1 of this subsection, for each specific drug on the formulary all of the following:
(a) Any utilization management edits, including prior authorization, step therapy edits, quantity limits or other requirements.
(b) Including any coinsurance requirement, the range of cost sharing for a potential enrollee if the drug is purchased in person at a network pharmacy, which may be indicated with a symbol and explained with a legend, in the following increments:
(i) Under one hundred dollars.
(ii) One hundred dollars to two hundred fifty dollars.
(iii) Two hundred fifty‑one dollars to five hundred dollars.
(iv) Over five hundred dollars.
(c) If the health insurer allows the option for mail-order pharmacy, the health insurer shall separately list the range of cost sharing for a potential enrollee if the potential enrollee purchases the drug through a mail-order facility using the same ranges and symbols and a legend as provided in subdivision (b) of this paragraph.
B. The formulary posted pursuant to subsection A, paragraph 1 of this section shall use a template that meets all of the following requirements:
1. Is standardized across all health plans offered by the health insurer.
2. Uses the United States pharmacopeia classification system.
3. Organizes drugs by therapeutic class, listing the drugs alphabetically.
4. Provides a separate list for drugs used to treat a serious illness covered under the health plan's medical benefit.
C. Each health insurer offering or renewing a health plan on or after January 1, 2017 shall make available to current and potential enrollees the information required by subsections A and B of this section. The information shall be available before the beginning of the open enrollment period and shall be available on a public website and through a toll‑free number that is posted on the health insurer's website.
D. Each health insurer offering or renewing a health plan on or after January 1, 2017 in this state, no later than thirty days after the offer or renewal date, shall attest to the director that the health insurer has satisfied the requirements of this section.
E. The director may adopt rules to implement this section.
F. For the purposes of this section:
1. "Formulary" means the complete list of drugs preferred for use and eligible for coverage under the health plan, including drugs covered under the health plan's pharmacy benefit and medical benefit as defined in rule by the director.
2. "Health insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation.
3. "Health plan":
(a) Means a policy, contract or evidence of coverage issued to an enrollee.
(b) Does not include limited benefit coverage as defined in section 20‑1137.