2012 -- S 2360

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LC01115

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

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A N A C T

RELATING TO INSURANCE - COVERAGE FOR PRESCRIPTION DRUGS

     Introduced By: Senators Nesselbush, Miller, Perry, Ottiano, and Pichardo

     Date Introduced: February 14, 2012

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-71. Coverage for prescription drugs. -- (a) Every individual or group health

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insurance contract, or every individual or group hospital or medical expense insurance policy,

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plan, or group policy issued for delivery, or renewed in this state on or after the passage of this

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act that provides coverage for prescription drugs shall not require an insured to use, prior to using

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a brand name prescription drug prescribed by a licensed prescriber, any alternative brand name

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prescription drugs or over-the-counter drugs.

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     (b) Health insurance contracts, plans or policies to which this section applies may require

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an insured to use, prior to using a brand name prescription drug prescribed by a licensed

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prescriber, a therapeutically equivalent generic drug, unless, pursuant to sections 5-19.1-19, 5-37-

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18.1 and subsection 21-31-15(b), the prescriber indicates “brand name necessary” on the

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prescription form, or if the prescriber gives oral direction to that effect to the dispensing

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pharmacist.

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     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations” is hereby amended by adding thereto the following section:

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     27-19-62. Coverage for prescription drugs. – (a) Every individual or group health

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insurance contract, or every individual or group hospital or medical expense insurance policy,

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plan, or group policy issued for delivery, or renewed in this state on or after the passage of this

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act that provides coverage for prescription drugs shall not require an insured to use, prior to using

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a brand name prescription drug prescribed by a licensed prescriber, any alternative brand name

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prescription drugs or over-the-counter drugs.

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     (b) Health insurance contracts, plans or policies to which this section applies may require

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an insured to use, prior to using a brand name prescription drug prescribed by a licensed

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prescriber, a therapeutically equivalent generic drug, unless, pursuant to sections 5-19.1-19, 5-37-

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18.1 and subsection 21-31-15(b), the prescriber indicates “brand name necessary” on the

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prescription form, or if the prescriber gives oral direction to that effect to the dispensing

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pharmacist.

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     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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Corporations” is hereby amended by adding thereto the following section:

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     27-20-57. Coverage for prescription drugs. – (a) Every individual or group health

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insurance contract, or every individual or group hospital or medical expense insurance policy,

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plan, or group policy issued for delivery, or renewed in this state on or after the passage of this

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act that provides coverage for prescription drugs shall not require an insured to use, prior to using

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a brand name prescription drug prescribed by a licensed prescriber, any alternative brand name

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prescription drugs or over-the-counter drugs.

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     (b) Health insurance contracts, plans or policies to which this section applies may require

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an insured to use, prior to using a brand name prescription drug prescribed by a licensed

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prescriber, a therapeutically equivalent generic drug, unless, pursuant to sections 5-19.1-19, 5-37-

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18.1 and subsection 21-31-15(b), the prescriber indicates “brand name necessary” on the

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prescription form, or if the prescriber gives oral direction to that effect to the dispensing

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pharmacist.

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     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations” is hereby amended by adding thereto the following section:

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     27-41-75. Coverage for prescription drugs. – (a) Every individual or group health

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insurance contract, or every individual or group hospital or medical expense insurance policy,

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plan, or group policy issued for delivery, or renewed in this state on or after the passage of this

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act that provides coverage for prescription drugs shall not require an insured to use, prior to using

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a brand name prescription drug prescribed by a licensed prescriber, any alternative brand name

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prescription drugs or over-the-counter drugs.

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     (b) Health insurance contracts, plans or policies to which this section applies may require

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an insured to use, prior to using a brand name prescription drug prescribed by a licensed

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prescriber, a therapeutically equivalent generic drug, unless, pursuant to sections 5-19.1-19, 5-37-

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18.1 and subsection 21-31-15(b), the prescriber indicates “brand name necessary” on the

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prescription form, or if the prescriber gives oral direction to that effect to the dispensing

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pharmacist.

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     SECTION 5. This act shall take effect upon passage.

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LC01115

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE - COVERAGE FOR PRESCRIPTION DRUGS

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     This act would prevent health insurance policies, plans or contracts that provide coverage

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for prescription drugs from requiring a beneficiary to use an alternative brand name prescription

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drug or over-the-counter drug prior to using a brand name prescription drug prescribed by a

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licensed physician.

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     This act would take effect upon passage.

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LC01115

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