2024 -- H 7518 | |
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LC004500 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
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A N A C T | |
RELATING TO INSURANCE -- PRESCRIPTION DRUG BENEFITS | |
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Introduced By: Representatives Morales, Batista, Donovan, Giraldo, Casimiro, Henries, | |
Date Introduced: February 07, 2024 | |
Referred To: House Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-20.8 of the General Laws entitled "Prescription Drug Benefits" is |
2 | hereby amended by adding thereto the following section: |
3 | 27-20.8-5. Co-pay cap for prescription inhaler, devices, and equipment. |
4 | (a) As used in this section, unless the context otherwise requires, "prescription inhaler” |
5 | means an inhaled medication for the treatment or prevention of an FDA approved respiratory |
6 | condition, and includes pressured metered dose inhalers (pMDI), dry powdered inhalers (DPI), soft |
7 | mist inhalers (SMI), and devices or equipment used to administer medications, such as nebulizers |
8 | and holding chambers. "Prescription inhaler" does not include inhalers available over-the-counter |
9 | without a prescription to provide temporary relief. |
10 | (b) A health plan that provides coverage for prescription inhalers and devices or equipment |
11 | used to administer such medications, pursuant to the terms of a health coverage plan the health plan |
12 | offers, shall cap the total amount that a covered person is required to pay for a covered prescription |
13 | inhaler, device or equipment used to administer such medications, at an amount not to exceed |
14 | twenty-five dollars ($25.00), per thirty (30) day supply. Coverage for prescription inhalers, device |
15 | or equipment used to administer such medications, shall not be subject to any deductible. |
16 | (c) Nothing in this section prevents a health plan from reducing a covered person's cost |
17 | sharing to an amount less than the amount specified in subsection (b) of this section. |
18 | (d) Prior authorization policies may only be used to confirm the presence of diagnoses or |
19 | other medical criteria and/or ensure that an item or service is medically necessary. |
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1 | (e) The office of the health insurance commissioner may use any of its enforcement powers |
2 | to obtain a health plan's compliance with this section. |
3 | (f) The office of the health insurance commissioner may promulgate rules and regulations |
4 | as necessary to implement and administer this section and to align with federal requirements. |
5 | SECTION 2. This act shall take effect on January 1, 2025. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- PRESCRIPTION DRUG BENEFITS | |
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1 | This act would cap the total amount that a covered person is required to pay for a covered |
2 | prescription inhaler, device, or equipment to twenty-five dollars ($25.00) per thirty (30) day supply. |
3 | This act would take effect on January 1, 2025. |
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