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Drug Coverage Health Plan

Concerning a prohibition against excluding a drug from a health coverage plan if the drug was approved by the plan for coverage of the covered person at the time the covered person enrolled in the plan.
2018 Regular Session
Health Care & Health Insurance
Bill Summary

The bill prohibits a health insurance carrier from excluding or limiting a drug under a health benefit plan and from moving the drug to a disadvantaged tier in the plan formulary if the drug was covered at the time the covered person enrolled in the plan. A carrier may not increase the amount that a covered person pays for a copayment, coinsurance, or deductible or set limits while the covered person is covered by the health benefit plan for drugs that were covered when the person became covered under the plan.

If a carrier uses a tiered plan, the carrier may not move a drug to a disadvantaged tier under specified circumstances.

A carrier may limit coverage for a drug or biosimilar product if a provider prescribes a generic drug or biosimilar product to treat the covered person's medical condition instead of the originally-prescribed drug and the covered person agrees.

(Note: This summary applies to this bill as introduced.)




Bill Text


Sponsor Type Legislators
Prime Sponsor

Rep. D. Esgar, Rep. J. Singer
Sen. C. Jahn



The effective date for bills enacted without a safety clause is August 7, 2024, if the General Assembly adjourns sine die on May 8, 2024, unless otherwise specified. Details