An Act To Provide Consumers of Health Care with Information Regarding Health Care Costs
Sec. 1. 24-A MRSA §4303, sub-§20 is enacted to read:
(1) The requirements for utilization review, prior authorization or step therapy for each category of prescription drug covered under a health plan;
(2) The cost-sharing requirements for prescription drug coverage, including a description of how the costs of prescription drugs will specifically be applied or not applied to any deductible or out-of-pocket maximum required under a health plan;
(3) The exclusions from coverage under a health plan and any restrictions on use or quantity of covered health care services in each category of benefits; and
(4) The amount of coverage provided under a health plan for out-of-network providers or noncovered health care services and any right of appeal available to an enrollee when out-of-network providers or noncovered health care services are medically necessary.
summary
This bill requires all health insurance carriers offering individual and group health plans to provide certain information with respect to prescription drug coverage to prospective enrollees and enrollees on its publicly accessible website. The bill requires carriers to post each prescription drug formulary for each health plan in a manner that allows enrollees to determine whether a particular prescription drug is covered under a formulary. The bill also requires carriers to provide information about utilization review, prior authorization or step therapy, cost-sharing, exclusions from coverage and the amount of coverage for out-of-network providers or noncovered health care services.