A bill proposed in the Ohio House of Representatives would require insurance companies to formally notify health providers, pharmacists and consumers prior to changing what prescription drugs an health plan covers.
Rep. Barbara Boyd, D-Cleveland and chair of the House Health Committee, introduced the proposal, House Bill 453. The bill applies to what are known as formularies, or lists of prescription drugs covered by a particular health plan.
The legislation seeks to require insurers to notify in writing its in-network health providers, pharmacies, pharmacists and plan enrollees when the insurer makes any of the following changes to its formulary:
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- Moves a prescription drug to a higher copay tier
- Substitutes a similar prescription drug for another
- Adds utilization management requirements for a prescription drug
Utilization management refers to decisions made by insurers about what type of care or treatment is appropriate for a patient. Opponents of the practice dislike it because they maintain that it takes medical decisions out of the hands of patients and doctors.
In addition to health insurers, the bill would apply to “sickness and accident” insurers and public employee benefit plans.
Boyd did not respond to two requests for comment.
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Association of Ohio Health Plans President Kelly McGivern says her group, which represents Ohio health insurers, has “concerns” about the proposal. She said the proposal would create too much of an administrative burden on health plans, especially considering events outside insurers’ control that could affect drug coverage, including new drug approvals, new generics hitting the market and drug recalls due to safety issues.
“House Bill 453 would not only create additional administrative costs within our health care system, it would also result in an upward pressure on premiums,” McGivern said.
In 2006, the George W. Bush administration changed Medicare rules to offer increased protection for patients whose prescription drug benefits are changed. Under the policy, insurers would still be able to drop drugs from their formularies. But if they drop drugs or add restrictions, insurers must exempt beneficiaries currently taking those drugs until the beneficiaries have the opportunity to enroll in new plans the following year.
