2014 -- H 7534

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LC004636

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO INSURANCE - COVERAGE FOR PRESCRIPTION DRUGS

     Introduced By: Representatives Cimini, Naughton, Ackerman, Martin, and Bennett

     Date Introduced: February 26, 2014

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-71. Coverage for prescription drugs. -- (a) Every individual or group health

insurance contract, or every individual or group hospital or medical expense insurance policy,

plan, or group policy issued for delivery, or renewed in this state on or after the enactment of this

section that provides coverage for prescription drugs shall not require an insured to use, prior to

using a brand name prescription drug prescribed by a licensed prescriber, any alternative brand

name prescription drugs or over-the-counter drugs.

     (b) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber, a therapeutically equivalent generic drug, unless, pursuant to §§ 5-19.1-19, 5-37-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 2. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-69. Coverage for prescription drugs. -- (a) Every individual or group health

insurance contract, or every individual or group hospital or medical expense insurance policy,

plan, or group policy issued for delivery, or renewed in this state on or after the enactment of this

section that provides coverage for prescription drugs shall not require an insured to use, prior to

using a brand name prescription drug prescribed by a licensed prescriber, any alternative brand

name prescription drugs or over-the-counter drugs.

     (b) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber, a therapeutically equivalent generic drug, unless, pursuant to §§ 5-19.1-19, 5-37-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 3. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-86. Coverage for prescription drugs. -- (a) Every individual or group health

insurance contract, or every individual or group hospital or medical expense insurance policy,

plan, or group policy issued for delivery, or renewed in this state on or after the enactment of this

section that provides coverage for prescription drugs shall not require an insured to use, prior to

using a brand name prescription drug prescribed by a licensed prescriber, any alternative brand

name prescription drugs or over-the-counter drugs.

     (b) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber, a therapeutically equivalent generic drug, unless, pursuant to §§ 5-19.1-19, 5-37-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 4. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - COVERAGE FOR PRESCRIPTION DRUGS

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     This act would prevent health insurance policies, plans or contracts that provide coverage

for prescription drugs from requiring a beneficiary to use an alternative brand name prescription

drug or over-the-counter drug prior to using a brand name prescription drug prescribed by a

licensed physician.

     This act would take effect upon passage.

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LC004636

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