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Introduced Version House Bill 4527 History

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H. B. 4527

 

(By Delegates Poore, Hatfield, Perdue,

                 Guthrie and D. Campbell)


[Introduced February 14, 2012; referred to the

Committee on Banking and Insurance then Health and Humnan Resources.]

 

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-27; to amend said code by adding thereto a new section, designated §33-15-22; to amend said code by adding thereto a new section, designated §33-16-3c; to amend said code by adding thereto a new section, designated §33-24-15; to amend said code by adding thereto a new section, designated §33-25-15; and to amend said code by adding thereto a new section, designated §33-25A-29, all relating to prohibiting a health insurance policy or health care plan that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations from reclassify a drug on the formulary as a specialty tier drug or increasing the cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary during the policy or plan year; and requiring thirty days notice prior to the beginning of the policy or plan year.

Be it enacted by the Legislature of West Virginia:

    That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §5-16-27; that said code by amended by adding thereto a new section, designated §33-15-22; that said code be amended by adding thereto a new section, designated §33-16-3c; that said code be amended by adding thereto a new section, designated §33-24-15; that said code be amended by adding thereto a new section, designated §33-25-15; and that said code be amended by adding thereto a new section, designated §33-25A-29, all to read as follows:

CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,

SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD

OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,

OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.

§5-16-27. Specialty tier drugs; formulary reclassification and increased charges prohibited during plan year.

    (a) Notwithstanding any provision in this article to the contrary, a health care plan that is issued or renewed under the provisions of this article, and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations, may not, prior to the annual anniversary date of the plan:

    (1) Reclassify a drug on the formulary as a specialty tier drug; or

    (2) Increase cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary.

    (b) The administrator for the plan shall give the enrollee at least thirty days' advance notice prior to the beginning of a plan year before impending a formulary change set forth in subdivision (1) or (2) of subsection (a) of this section.

CHAPTER 33. INSURANCE.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-22. Specialty tier drugs; formulary reclassification and increased charges prohibited during policy or plan year.

    (a) Notwithstanding any provision in this article to the contrary, a health insurance policy or health care plan that is issued or renewed under the provisions of this article, and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations, may not, prior to the annual anniversary date of the policy or plan:

    (1) Reclassify a drug on the formulary as a specialty tier drug; or

    (2) Increase cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary.

    (b) The administrator for the policy or plan shall give the enrollee at least thirty days' advance notice prior to the beginning of a policy or plan year before impending a formulary change set forth in subdivision (1) or (2) of subsection (a) of this section.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3c. Specialty tier drugs; formulary reclassification and increased charges prohibited during policy or plan year.

    (a) Notwithstanding any provision in this article to the contrary, a health insurance policy or health care plan that is issued or renewed under the provisions of this article, and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations, may not, prior to the annual anniversary date of the policy or plan:

    (1) Reclassify a drug on the formulary as a specialty tier drug; or

    (2) Increase cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary.

    (b) The administrator for the policy or plan shall give the enrollee at least thirty days' advance notice prior to the beginning of a policy or plan year before impending a formulary change set forth in subdivision (1) or (2) of subsection (a) of this section.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§33-24-15. Specialty tier drugs; formulary reclassification and increased charges prohibited during policy or plan year.

    (a) Notwithstanding any provision in this article to the contrary, a health insurance policy or health care plan that is issued or renewed under the provisions of this article, and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations, may not, prior to the annual anniversary date of the policy or plan:

    (1) Reclassify a drug on the formulary as a specialty tier drug; or

    (2) Increase cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary.

    (b) The administrator for the policy or plan shall give the enrollee at least thirty days' advance notice prior to the beginning of a policy or plan year before impending a formulary change set forth in subdivision (1) or (2) of subsection (a) of this section.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-15. Specialty tier drugs; formulary reclassification and increased charges prohibited during policy or plan year.

    (a) Notwithstanding any provision in this article to the contrary, a health insurance policy or health care plan that is issued or renewed under the provisions of this article, and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations, may not, prior to the annual anniversary date of the policy or plan:

    (1) Reclassify a drug on the formulary as a specialty tier drug; or

    (2) Increase cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary.

    (b) The administrator for the policy or plan shall give the enrollee at least thirty days' advance notice prior to the beginning of a policy or plan year before impending a formulary change set forth in subdivision (1) or (2) of subsection (a) of this section.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-29. Specialty tier drugs; formulary reclassification and increased charges prohibited during policy or plan year.

    (a) Notwithstanding any provision in this article to the contrary, a health insurance policy or health care plan that is issued or renewed under the provisions of this article, and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations, may not, prior to the annual anniversary date of the policy or plan:

    (1) Reclassify a drug on the formulary as a specialty tier drug; or

    (2) Increase cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary.

    (b) The administrator for the policy or plan shall give the enrollee at least thirty days' advance notice prior to the beginning of a policy or plan year before impending a formulary change set forth in subdivision (1) or (2) of subsection (a) of this section.


    NOTE: The purpose of this bill is to prohibit a health insurance policy or health care plan that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations from reclassing a drug on the formulary as a specialty tier drug or increasing the cost-sharing, copayment, deductible or coinsurance charges for an existing specialty tier drug on the formulary during the policy or plan year. The bill requires thirty days’ notice prior to the beginning of the policy or plan year to implement those changes.


    §5-16-27, §33-15-22, §33-16-3c, §33-24-15, §33-25-15 and §33-25A-29 are new; therefore, it has been completely underscored.

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