2013 -- H 5591

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LC01345

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO INSURANCE - PRESCRIPTION DRUGS - BENEFITS

     Introduced By: Representatives Keable, Ajello, Tanzi, and Cimini

     Date Introduced: February 27, 2013

     Referred To: House Corporations

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-20.8-2 of the General Laws in Chapter 27-20.8 entitled

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"Prescription Drug Benefits" is hereby amended to read as follows:

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

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pharmacy benefits shall comply with the following:

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      (a) When a A health plan's pharmacy benefit has shall not have a dollar limit, the

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insured's use of such benefit shall be determined based on the health plan's contracted rate to

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purchase the drug minus the enrollee's applicable co-payment for covered drugs. The balance will

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apply towards the enrollee's dollars limit.

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      (b) Each health plan shall establish a separate out-of-pocket limit for prescription drugs,

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including specialty drugs, equal to the maximum dollar amounts in effect under section 223(b)(2)

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of the internal revenue code for self-only and family coverage, respectively. For the purposes of

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this section, the use of the term "out-of-pocket limit" must be consistent with the definitions of

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those terms as prescribed by the secretary of the United States department of health and human

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services pursuant to section 2715 of the federal affordable care act.

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

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

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

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

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     (d) Nothing in this section shall apply to title XIX state plan pursuant to title XIX of the

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social security act to provide Medicaid coverage or title XXI state plan pursuant to title XXI of

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the social security act to provide medical assistance coverage. The services provided shall be in

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accord with title XIX [42 U.S.C. et seq.] and title XXI [42 U.S.C. section 1397 et seq.] of the

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social security act.

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     SECTION 2. This act shall take effect upon passage.

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LC01345

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE - PRESCRIPTION DRUGS - BENEFITS

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     This act would eliminate dollars limits on health plans pharmacy benefits and would

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provide that each health plan establish a separate out-of-pocket limit for prescription drugs equal

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to the maximum amount in effect under section 223(b)(2) of the internal revenue code for self-

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only and family coverage.

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     This act would take effect upon passage.

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LC01345

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