2024 -- S 2255 | |
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LC004687 | |
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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 -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- | |
INSURANCE COVERAGE FOR PREVENTION OF HIV INFECTION | |
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Introduced By: Senators Murray, Pearson, Miller, Sosnowski, Bissaillon, Valverde, | |
Date Introduced: February 06, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-18-91 of the General Laws in Chapter 27-18 entitled "Accident |
2 | and Sickness Insurance Policies" is hereby amended to read as follows: |
3 | 27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the |
4 | prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective |
5 | January 1, 2024.] |
6 | (a) Every group health insurance contract, or every group hospital or medical expense |
7 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
8 | any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of |
9 | pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis |
10 | (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall |
11 | constitute a separate method of administration. A health insurer is not required to cover any pre- |
12 | exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out- |
13 | of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network |
14 | pharmacy benefit. |
15 | (b) The healthcare benefits outlined in this chapter apply only to services delivered within |
16 | the health insurer’s provider network; provided that, all health insurers shall be required to provide |
17 | coverage for those benefits mandated by this chapter outside of the health insurer’s provider |
18 | network where it can be established that the required services are not available from a provider in |
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1 | the health insurer’s network. |
2 | (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any |
3 | HIV prevention drug to any prior authorization or step therapy requirement. There shall be no |
4 | copayment required, and no deductible shall need to be met, to obtain the prescription covered by |
5 | the contract, plan, or policy. |
6 | SECTION 2. Section 27-18-92 of the General Laws in Chapter 27-18 entitled "Accident |
7 | and Sickness Insurance Policies" is hereby repealed. |
8 | 27-18-92. Expedited prior authorization. [Effective January 1, 2024.] |
9 | To the extent a prior authorization is permitted and applied, then it shall be conducted in |
10 | an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27- |
11 | 18.9-6(a)(1). |
12 | SECTION 3. Section 27-19-83 of the General Laws in Chapter 27-19 entitled "Nonprofit |
13 | Hospital Service Corporations" is hereby amended to read as follows: |
14 | 27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the |
15 | prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective |
16 | January 1, 2024.] |
17 | (a) Every group health insurance contract, or every group hospital or medical expense |
18 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
19 | any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of |
20 | pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis |
21 | (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall |
22 | constitute a separate method of administration. A health insurer is not required to cover any pre- |
23 | exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out- |
24 | of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network |
25 | pharmacy benefit. |
26 | (b) The healthcare benefits outlined in this chapter apply only to services delivered within |
27 | the health insurer’s provider network; provided that, all health insurers shall be required to provide |
28 | coverage for those benefits mandated by this chapter outside of the health insurer’s provider |
29 | network where it can be established that the required services are not available from a provider in |
30 | the health insurer’s network. |
31 | (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any |
32 | HIV prevention drug to any prior authorization or step therapy requirement. There shall be no |
33 | copayment required, and no deductible shall need to be met, to obtain the prescription covered by |
34 | the contract, plan, or policy. |
| LC004687 - Page 2 of 5 |
1 | SECTION 4. Section 27-19-84 of the General Laws in Chapter 27-19 entitled "Nonprofit |
2 | Hospital Service Corporations" is hereby repealed. |
3 | 27-19-84. Expedited prior authorization. [Effective January 1, 2024.] |
4 | To the extent a prior authorization is permitted and applied, then it shall be conducted in |
5 | an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27- |
6 | 18.9-6(a)(1). |
7 | SECTION 5. Section 27-20-79 of the General Laws in Chapter 27-20 entitled "Nonprofit |
8 | Medical Service Corporations" is hereby amended to read as follows: |
9 | 27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the |
10 | prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective |
11 | January 1, 2024.] |
12 | (a) Every group health insurance contract, or every group hospital or medical expense |
13 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
14 | any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of |
15 | pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis |
16 | (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall |
17 | constitute a separate method of administration. A health insurer is not required to cover any pre- |
18 | exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out- |
19 | of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network |
20 | pharmacy benefit. |
21 | (b) The healthcare benefits outlined in this chapter apply only to services delivered within |
22 | the health insurer’s provider network; provided that, all health insurers shall be required to provide |
23 | coverage for those benefits mandated by this chapter outside of the health insurer’s provider |
24 | network where it can be established that the required services are not available from a provider in |
25 | the health insurer’s network. |
26 | (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any |
27 | HIV prevention drug to any prior authorization or step therapy requirement. There shall be no |
28 | copayment required, and no deductible shall need to be met, to obtain the prescription covered by |
29 | the contract, plan, or policy. |
30 | SECTION 6. Section 27-20-80 of the General Laws in Chapter 27-20 entitled "Nonprofit |
31 | Medical Service Corporations" is hereby repealed. |
32 | 27-20-80. Expedited prior authorization. [Effective January 1, 2024.] |
33 | To the extent a prior authorization is permitted and applied, then it shall be conducted in |
34 | an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27- |
| LC004687 - Page 3 of 5 |
1 | 18.9-6(a)(1). |
2 | SECTION 7. Section 27-41-96 of the General Laws in Chapter 27-41 entitled "Health |
3 | Maintenance Organizations" is hereby amended to read as follows: |
4 | 27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the |
5 | prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective |
6 | January 1, 2024.] |
7 | (a) Every group health insurance contract, or every group hospital or medical expense |
8 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
9 | any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of |
10 | pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis |
11 | (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall |
12 | constitute a separate method of administration. A health insurer is not required to cover any pre- |
13 | exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out- |
14 | of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network |
15 | pharmacy benefit. |
16 | (b) The healthcare benefits outlined in this chapter apply only to services delivered within |
17 | the health insurer’s provider network; provided that, all health insurers shall be required to provide |
18 | coverage for those benefits mandated by this chapter outside of the health insurer’s provider |
19 | network where it can be established that the required services are not available from a provider in |
20 | the health insurer’s network. |
21 | (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any |
22 | HIV prevention drug to any prior authorization or step therapy requirement. There shall be no |
23 | copayment required, and no deductible shall need to be met, to obtain the prescription covered by |
24 | the contract, plan, or policy. |
25 | SECTION 8. Section 27-41-97 of the General Laws in Chapter 27-41 entitled "Health |
26 | Maintenance Organizations" is hereby repealed. |
27 | 27-41-97. Expedited prior authorization. [Effective January 1, 2024.] |
28 | To the extent a prior authorization is permitted and applied, then it shall be conducted in |
29 | an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27- |
30 | 18.9-6(a)(1). |
31 | SECTION 9. This act shall take effect on January 1, 2025. |
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LC004687 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- | |
INSURANCE COVERAGE FOR PREVENTION OF HIV INFECTION | |
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1 | This act would eliminate prior authorization or step therapy requirement for prescriptions |
2 | for any HIV prevention drug. This act would also prohibit the requirement of any copayment or the |
3 | meeting of any deductible to obtain the prescription covered by the contract, plan, or policy. |
4 | This act would take effect on January 1, 2025. |
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LC004687 | |
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