Chapter 370

2004 -- H 8127 SUBSTITUTE A

Enacted 07/05/04

A N A C T

RELATING TO HEALTH AND SAFETY -- HEALTH CARE ACCESSIBILITY ASSURANCE

Introduced By: Representatives Anguilla, Kilmartin, Gallison, Shanley, and Rose

Date Introduced: February 24, 2004

It is enacted by the General Assembly as follows:

     SECTION 1. Title 27 of the General Laws entitled "Insurance" is hereby amended by

adding thereto the following chapter:

CHAPTER 20.8

PRESCRIPTION DRUG BENEFITS

27-20.8-1. Definitions. – For the purposes of this chapter, the following terms shall

mean:

(a) "Director" shall mean the director of the department of business regulation.

(b) "Health plan" shall mean an insurance carrier as defined in chapters 18, 19, 20 and 41

of title 27.

(c) "Insured" shall mean any person who is entitled to have pharmacy services paid by a

health plan pursuant to a policy, certificate, contract or agreement of insurance or coverage

including those administered for the health plan under a contract with a third-party administrator

that manages pharmacy benefits or pharmacy network contracts.

27-20.8-2. Pharmacy benefit, limits and co-payments. – Any health plan that offers

pharmacy benefits shall comply with the following:

(a) When a health plan's pharmacy benefit has a dollar limit, the insured's use of such

benefit shall be determined based on the health plan's contracted rate to purchase the drug minus

the enrollee's applicable co-payment for covered drugs. The balance will apply towards the

enrollee's dollars limit.

(b) When a health plan charges a co-payment for covered prescription drugs that is based

on a percent of the drug cost, the health plan shall disclose within the group policy or individual

policy benefits description statement whether the co-payment is based on the plan's contracted

rate to purchase the drug or some other cost basis such as retail price.

     SECTION 2. This act shall take effect upon passage.

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LC01972/SUB A

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