Bill Text: HI HB2096 | 2010 | Regular Session | Introduced
Bill Title: Prescription Drug Formulary
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2010-02-24 - (H) The committee(s) recommends that the measure be deferred. [HB2096 Detail]
Download: Hawaii-2010-HB2096-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
2096 |
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TWENTY-FIFTH LEGISLATURE, 2010 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to prescription drugs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A, part I to be appropriately designated and to read as follows:
"§431:10A- Drug formulary board. (a) No insurer that provides individual and group accident and health and sickness insurance policies and that bases coverage for prescription drugs on a drug formulary or prior authorization requirement shall employ a drug formulary or prior authorization requirement for prescription drug coverage unless the formulary or authorization requirement has been developed by a drug formulary board established pursuant to this section.
(b) Every insurer that provides individual and group accident and health and sickness insurance policies that include coverage for prescription drugs and that bases prescription drug coverage on drug formularies or prior authorization requirements shall establish a drug formulary board that complies with the standards established by this section. A drug formulary board established pursuant to this section shall consist of at least eleven members, of which eight shall consist of the following:
(1) One person licensed by the Hawaii medical board who practices medicine in the area of general medicine or adult internal medicine;
(2) One person licensed by the Hawaii medical board who practices medicine in the area of obstetrics and gynecology;
(3) One person licensed by the Hawaii medical board who practices medicine in the area of pediatric medicine;
(4) One person licensed by the Hawaii medical board who practices medicine in the area of geriatric medicine;
(5) One person who is licensed by the board of nursing as an advanced practice nurse practitioner with prescriptive authority; and
(6) Three persons licensed as pharmacists by the board of pharmacy.
At least eight of the members of each drug formulary board established pursuant to this section shall be employed in at least a half-time capacity as practitioners in the fields of their respective licensure during their tenure on the drug formulary board.
(c) Each drug formulary board established pursuant to this section shall establish a prescription drug formulary and prior authorization requirement for the insurer with which the drug formulary board is associated. Each drug formulary board shall meet at least two times per calendar year to review and update the drug formulary and prior authorization requirements established pursuant to this section. Prescription drug formularies and prior authorization requirements established and updated pursuant to this section shall be based on analysis of drug safety and efficacy using appropriate medical and scientific evidence.
(d) Each insurer subject to this section shall establish its own rules and policies to govern the drug formulary board that the insurer establishes pursuant to this section. Rules and policies governing the drug formulary board shall be included with each rate filing submitted to the commissioner pursuant to subsection (e).
(e) Each insurer shall file the prescription drug formulary and prior authorization requirement established and each update to the prescription drug formulary and prior authorization requirement enacted pursuant to subsection (c) with the commissioner as a rate filing subject to chapter 431:14G.
(f) For purposes of this section:
"Prescription drug formulary" means a list of prescription drugs for which an insurer provides coverage at a defined benefit level either directly to a policy holder or indirectly through a contractual relationship with another corporate entity such as a pharmacy benefits manager.
"Prior authorization requirement" means an insurer's requirement for specific and individualized approval by the insurer before certain prescription drugs are covered at any benefit level by a policy of accident and health and sickness insurance."
SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A, part II to be appropriately designated and to read as follows:
"§431:10A- Drug formulary board. (a) No insurer that provides group and blanket disability insurance and that bases coverage for prescription drugs on a drug formulary or prior authorization requirement shall employ a drug formulary or prior authorization requirement for prescription drug coverage unless the formulary or authorization requirement has been developed by a drug formulary board established pursuant to this section.
(b) Every insurer that provides group and blanket disability insurance policies that include coverage for prescription drugs and that bases prescription drug coverage on drug formularies or prior authorization requirements shall establish a drug formulary board that complies with the standards established by this section. A drug formulary board established pursuant to this section shall consist of at least eleven members, of which eight shall consist of the following:
(1) One person licensed by the Hawaii medical board who practices medicine in the area of general medicine or adult internal medicine;
(2) One person licensed by the Hawaii medical board who practices medicine in the area of obstetrics and gynecology;
(3) One person licensed by the Hawaii medical board who practices medicine in the area of pediatric medicine;
(4) One person licensed by the Hawaii medical board who practices medicine in the area of geriatric medicine;
(5) One person who is licensed by the board of nursing as an advanced practice nurse practitioner with prescriptive authority; and
(6) Three persons licensed as pharmacists by the board of pharmacy.
At least eight of the members of each drug formulary board established pursuant to this section shall be employed in at least a half-time capacity as practitioners in the fields of their respective licensure during their tenure on the drug formulary board.
(c) Each drug formulary board established pursuant to this section shall establish a prescription drug formulary and prior authorization requirement for the insurer with which the drug formulary board is associated. Each drug formulary board shall meet at least two times per calendar year to review and update the drug formulary and prior authorization requirements established pursuant to this section. Prescription drug formularies and prior authorization requirements established and updated pursuant to this section shall be based on analysis of drug safety and efficacy using appropriate medical and scientific evidence.
(d) Each insurer subject to this section shall establish its own rules and policies to govern the drug formulary board that the insurer establishes pursuant to this section. Rules and policies governing the drug formulary board shall be included with each rate filing submitted to the commissioner pursuant to subsection (e).
(e) Each insurer shall file the prescription drug formulary and prior authorization requirement established and each update to the prescription drug formulary and prior authorization requirement enacted pursuant to subsection (c) with the commissioner as a rate filing subject to chapter 431:14G.
(f) For purposes of this section:
"Prescription drug formulary" means a list of prescription drugs for which an insurer provides coverage at a defined benefit level either directly to a policy holder or indirectly through a contractual relationship with another corporate entity such as a pharmacy benefits manager.
"Prior authorization requirement" means an insurer's requirement for specific and individualized approval by the insurer before certain prescription drugs are covered at any benefit level by a policy of accident and health and sickness insurance."
SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:
"§432:1- Drug formulary board. (a) No mutual benefit society that bases coverage for prescription drugs on a drug formulary or prior authorization requirement shall employ a drug formulary or prior authorization requirement for prescription drug coverage unless the formulary or authorization requirement has been developed by a drug formulary board established pursuant to this section.
(b) Every mutual benefit society that provides coverage for prescription drugs and that bases prescription drug coverage on drug formularies or prior authorization requirements shall establish a drug formulary board that complies with the standards established by this section. A drug formulary board established pursuant to this section shall consist of at least eleven members, of which eight shall consist of the following:
(1) One person licensed by the Hawaii medical board who practices medicine in the area of general medicine or adult internal medicine;
(2) One person licensed by the Hawaii medical board who practices medicine in the area of obstetrics and gynecology;
(3) One person licensed by the Hawaii medical board who practices medicine in the area of pediatric medicine;
(4) One person licensed by the Hawaii medical board who practices medicine in the area of geriatric medicine;
(5) One person who is licensed by the board of nursing as an advanced practice nurse practitioner with prescriptive authority; and
(6) Three persons licensed as pharmacists by the board of pharmacy.
At least eight of the members of each drug formulary board established pursuant to this section shall be employed in at least a half-time capacity as practitioners in the fields of their respective licensure during their tenure on the drug formulary board.
(c) Each drug formulary board established pursuant to this section shall establish a prescription drug formulary and prior authorization requirement for the mutual benefit society with which the drug formulary board is associated. Each drug formulary board shall meet at least two times per calendar year to review and update the drug formulary and prior authorization requirements established pursuant to this section. Prescription drug formularies and prior authorization requirements established and updated pursuant to this section shall be based on analysis of drug safety and efficacy using appropriate medical and scientific evidence.
(d) Each mutual benefit society subject to this section shall establish its own rules and policies to govern the drug formulary board that the mutual benefit society establishes pursuant to this section. Rules and policies governing the drug formulary board shall be included with each rate filing submitted to the commissioner pursuant to subsection (e).
(e) Each mutual benefit society shall file the prescription drug formulary and prior authorization requirement established and each update to the prescription drug formulary and prior authorization requirement enacted pursuant to subsection (c) with the commissioner as a rate filing subject to chapter 431:14G.
(f) For purposes of this section:
"Prescription drug formulary" means a list of prescription drugs for which a mutual benefit society provides coverage at a defined benefit level either directly to a member or indirectly through a contractual relationship with another corporate entity such as a pharmacy benefits manager.
"Prior authorization requirement" means a mutual benefit society's requirement for specific and individualized approval by the mutual benefit society before certain prescription drugs are covered at any benefit level by a policy of accident and health and sickness insurance."
SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 2 to be appropriately designated and to read as follows:
"§432:2- Drug formulary board. (a) No fraternal benefit society that bases coverage for prescription drugs on a drug formulary or prior authorization requirement shall employ a drug formulary or prior authorization requirement for prescription drug coverage unless the formulary or authorization requirement has been developed by a drug formulary board established pursuant to this section.
(b) Every fraternal benefit society that provides coverage for prescription drugs and that bases prescription drug coverage on drug formularies or prior authorization requirements shall establish a drug formulary board that complies with the standards established by this section. A drug formulary board established pursuant to this section shall consist of at least eleven members, of which eight shall consist of the following:
(1) One person licensed by the Hawaii medical board who practices medicine in the area of general medicine or adult internal medicine;
(2) One person licensed by the Hawaii medical board who practices medicine in the area of obstetrics and gynecology;
(3) One person licensed by the Hawaii medical board who practices medicine in the area of pediatric medicine;
(4) One person licensed by the Hawaii medical board who practices medicine in the area of geriatric medicine;
(5) One person who is licensed by the board of nursing as an advanced practice nurse practitioner with prescriptive authority; and
(6) Three persons licensed as pharmacists by the board of pharmacy.
At least eight of the members of each drug formulary board established pursuant to this section shall be employed in at least a half-time capacity as practitioners in the fields of their respective licensure during their tenure on the drug formulary board.
(c) Each drug formulary board established pursuant to this section shall establish a prescription drug formulary and prior authorization requirement for the fraternal benefit society with which the drug formulary board is associated. Each drug formulary board shall meet at least two times per calendar year to review and update the drug formulary and prior authorization requirements established pursuant to this section. Prescription drug formularies and prior authorization requirements established and updated pursuant to this section shall be based on analysis of drug safety and efficacy using appropriate medical and scientific evidence.
(d) Each fraternal benefit society subject to this section shall establish its own rules and policies to govern the drug formulary board that the fraternal benefit society establishes pursuant to this section. Rules and policies governing the drug formulary board shall be included with each rate filing submitted to the commissioner pursuant to subsection (e).
(e) Each fraternal benefit society shall file the prescription drug formulary and prior authorization requirement established and each update to the prescription drug formulary and prior authorization requirement enacted pursuant to subsection (c) with the commissioner as a rate filing subject to chapter 431:14G.
(f) For purposes of this section:
"Prescription drug formulary" means a list of prescription drugs for which a fraternal benefit society provides coverage at a defined benefit level either directly to a member or indirectly through a contractual relationship with another corporate entity such as a pharmacy benefits manager.
"Prior authorization requirement" means a fraternal benefit society's requirement for specific and individualized approval by the fraternal benefit society before certain prescription drugs are covered at any benefit level by a policy of accident and health and sickness insurance."
SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432D- Drug formulary board. (a) No health maintenance organization that bases coverage for prescription drugs on a drug formulary or prior authorization requirement shall employ a drug formulary or prior authorization requirement for prescription drug coverage unless the formulary or authorization requirement has been developed by a drug formulary board established pursuant to this section.
(b) Every health maintenance organization that provides coverage for prescription drugs and that bases prescription drug coverage on drug formularies or prior authorization requirements shall establish a drug formulary board that complies with the standards established by this section. A drug formulary board established pursuant to this section shall consist of at least eleven members, of which eight shall consist of the following:
(1) One person licensed by the Hawaii medical board who practices medicine in the area of general medicine or adult internal medicine;
(2) One person licensed by the Hawaii medical board who practices medicine in the area of obstetrics and gynecology;
(3) One person licensed by the Hawaii medical board who practices medicine in the area of pediatric medicine;
(4) One person licensed by the Hawaii medical board who practices medicine in the area of geriatric medicine;
(5) One person who is licensed by the board of nursing as an advanced practice nurse practitioner with prescriptive authority; and
(6) Three persons licensed as pharmacists by the board of pharmacy.
At least eight of the members of each drug formulary board established pursuant to this section shall be employed in at least a half-time capacity as practitioners in the fields of their respective licensure during their tenure on the drug formulary board.
(c) Each drug formulary board established pursuant to this section shall establish a prescription drug formulary and prior authorization requirement for the health maintenance organization with which the drug formulary board is associated. Each drug formulary board shall meet at least two times per calendar year to review and update the drug formulary and prior authorization requirements established pursuant to this section. Prescription drug formularies and prior authorization requirements established and updated pursuant to this section shall be based on analysis of drug safety and efficacy using appropriate medical and scientific evidence.
(d) Each health maintenance organization subject to this section shall establish its own rules and policies to govern the drug formulary board that the health maintenance organization establishes pursuant to this section. Rules and policies governing the drug formulary board shall be included with each rate filing submitted to the commissioner pursuant to subsection (e).
(e) Each health maintenance organization shall file the prescription drug formulary and prior authorization requirement established and each update to the prescription drug formulary and prior authorization requirement enacted pursuant to subsection (c) with the commissioner as a rate filing subject to chapter 431:14G.
(f) For purposes of this section:
"Prescription drug formulary" means a list of prescription drugs for which a health maintenance organization provides coverage at a defined benefit level either directly to a member or indirectly through a contractual relationship with another corporate entity such as a pharmacy benefits manager.
"Prior authorization requirement" means a health maintenance organization's requirement for specific and individualized approval by the health maintenance organization before certain prescription drugs are covered at any benefit level by a policy of accident and health and sickness insurance."
SECTION 6. New statutory material is underscored.
SECTION 7. This Act shall take effect on July 1, 2010.
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INTRODUCED BY: |
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Report Title:
Prescription Drug Formulary
Description:
Requires providers of accident or health and sickness insurance to base prescription drug coverage on a drug formulary or prior authorization requirements established and regularly updated by a drug formulary advisory board whose membership includes practicing physicians, pharmacists, and health care practitioners.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
