Julie McGuire
- Republican
- Representative
- District 93
Author
Requires an insurer, an administrator, and a pharmacy benefit manager to apply the annual limitation on cost sharing set forth in the federal Patient Protection and Affordable Care Act under 42 U.S.C. 18022(c)(1) to prescription drugs that: (1) are covered under a health plan; (2) are life-saving or intended to manage chronic pain; and (3) do not have an approved generic version. Provides that an insurer, an administrator, and a pharmacy benefit manager may not directly or indirectly set, alter, implement, or condition the terms of health insurance coverage based in part or entirely on information about the availability or amount of financial or product assistance available for a prescription drug. Requires, before December 31 of each year, each insurer and administrator to certify to the insurance commissioner that the insurer or administrator has fully and completely complied with the cost sharing requirements during the previous calendar year. Requires a health plan to credit toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the covered individual pays directly to any health care provider for a medically necessary covered health care service if a claim for the health care service is not submitted to the health plan and the amount paid by the covered individual to the health care provider is less than the average discounted rate for the health care service paid to a health care provider in the health plan's network. Requires a health plan to: (1) establish a procedure by which a covered individual may claim a credit; and (2) identify documentation necessary to support a claim for a credit.
Signed by the Governor
Public Law 237
Signed by the President of the Senate
Signed by the President Pro Tempore
Signed by the Speaker
Conference Committee Report 1: adopted by the Senate; Roll Call 493: yeas 45, nays 2
Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 521: yeas 91, nays 0
CCR # 1 filed in the House
CCR # 1 filed in the Senate
Senate advisors appointed: Randolph Lonnie M and Walker K
Senate conferees appointed: Carrasco and Qaddoura
House conferees appointed: McGuire and Shackleford
Motion to dissent filed
House dissented from Senate amendments
House advisors appointed: King, Barrett, Campbell and Dant Chesser
Returned to the House with amendments
Senator Rogers added as cosponsor
Senator Yoder added as cosponsor
Third reading: passed; Roll Call 293: yeas 44, nays 3
Senator Bohacek added as cosponsor
Second reading: ordered engrossed
Committee report: amend do pass, adopted
Senator Qaddoura added as cosponsor
Senator Ford J.D. added as cosponsor
Senator Hunley added as cosponsor
Senator Randolph added as cosponsor
First reading: referred to Committee on Insurance and Financial Institutions
Referred to the Senate
Senate sponsors: Senators Carrasco, Walker K, Freeman
Third reading: passed; Roll Call 187: yeas 95, nays 0
Second reading: ordered engrossed
Committee report: amend do pass, adopted
Representative Shackleford added as coauthor
Coauthored by Representatives King and Morris
Authored by Representative McGuire
| Bill Text Versions | Format |
|---|---|
| Enrolled House Bill (H) | |
| House Bill (H) | |
| House Bill (S) | |
| Introduced House Bill (H) |
| Document | Format |
|---|---|
| Fiscal Note: HB1604.04.ENRS.FN001 |
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