HP0396, LD 572, item 1, An Act To Ensure Appropriate Health Insurance Coverage for Prescription Eye Drops

An Act To Ensure Appropriate Health Insurance Coverage for Prescription Eye Drops

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4314-A is enacted to read:

§ 4314-A. Coverage for early refills of prescription eye drops

1. Required coverage. A carrier offering a health plan in this State shall provide coverage for one early refill of a prescription for eye drops if the following criteria are met:

A. For prescription eye drops dispensed as a 30-day supply, the enrollee requests the refill fewer than 30 days after the later of the following dates:

(1) The date the original prescription was dispensed to the enrollee; or

(2) The date that the most recent refill of the prescription was dispensed to the enrollee;

B. For prescription eye drops dispensed as a 90-day supply, the enrollee requests the refill fewer than 90 days after the later of the following dates:

(1) The date the original prescription was dispensed to the enrollee; or

(2) The date that the most recent refill of the prescription was dispensed to the enrollee;

C. The prescribing health care provider indicated on the original prescription that a specific number of refills are authorized;

D. The refill requested by the enrollee does not exceed the number of refills indicated on the original prescription;

E. The prescription has not been refilled more than once during the 30-day or 90-day period prior to the request for an early refill; and

F. The prescription eye drops are a covered benefit under the enrollee's health plan.

2. Cost sharing. A carrier may not impose a deductible, copayment or coinsurance requirement for coverage required under this section as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to other prescription drug coverage under the health plan.

Sec. 2. Application. The requirements of this Act apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2016. For purposes of this Act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.

SUMMARY

This bill requires all health insurance carriers offering health plans to provide coverage for early refills of prescription eye drop medication in certain circumstances. The bill applies to all policies and contracts issued or renewed on or after January 1, 2016.

HP0396 LD 572	Session - 127th Maine Legislature		LR 1566 Item 1
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