2014 -- S 2358

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LC004176

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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: Senators Crowley, Sosnowski, Metts, and Pichardo

     Date Introduced: February 12, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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

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

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

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

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

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name prescription drugs or over-the-counter drugs.

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

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

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

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

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

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

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

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

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

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

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

 

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

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name prescription drugs or over-the-counter drugs.

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

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

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

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

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

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

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

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

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

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

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

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

15

name prescription drugs or over-the-counter drugs.

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

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

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

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

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

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     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

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

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

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licensed physician.

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     This act would take effect upon passage.

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LC004176

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LC004176 - Page 3 of 3