2013 -- S 0754

=======

LC02012

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

____________

A N A C T

RELATING TO INSURANCE - PRESCRIPTION DRUG BENEFITS

     Introduced By: Senator Donna M. Nesselbush

     Date Introduced: March 13, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

1-1

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

1-2

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

1-3

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

1-4

pharmacy benefits shall comply with the following:

1-5

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

1-6

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

1-7

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

1-8

apply towards the enrollee's dollars limit.

1-9

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

1-10

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

1-11

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

1-12

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

1-13

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

1-14

pursuant to section 2715 of the affordable care act.

1-15

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

1-16

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

1-17

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

1-18

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

1-19

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

1-20

the social security act to provide medicaid coverage or title XXI state plan pursuant to title XXI

2-1

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

2-2

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

2-3

security act.

2-4

     SECTION 2. This act shall take effect upon passage.

=======

LC02012

=======

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE - PRESCRIPTION DRUG BENEFITS

***

3-1

     This act would mandate that a health plan’s pharmacy benefit shall not have a dollar

3-2

limit. Each health plan would establish that a separate out-of-pocket limit would be for

3-3

prescription drugs, including specialty drugs, equal to the maximum dollar amounts in effect

3-4

under section 223(b)(2) of the Internal Revenue Code for self-only and family coverage,

3-5

respectively.

3-6

     This act would take effect upon passage.

=======

LC02012

=======