On Apr. 16, IOW LEG passed bill, insurer use of nonmedical switching.
IOW LEG passed bill HF 626, formerly HF 96, re prescription drug coverage by plans.
New IOW INS 514F.9 (utilization/cost control, continuity of care nonmedical switching)
Address situations where insurers use nonmedical switching to move policyholders from more costly prescriptions to medications that may be cheaper or less effective.
Key Provisions
Health carrier, health benefit plan or utilization review organization cannot limit or exclude prescription drug coverage for covered persons medically stable on the drug.
Prescription must be prior approved, prescribed for the condition within last 6 months.
Prohibit insurer from limiting coverage or moving prescription to a more restrictive tier.
Legislative History
On Mar. 6, 2023, bill introduced in House; on Apr. 17, 2024, bill passed in the House.
On Mar. 13, 2023, bill introduced in Senate; on Apr. 16, 2024, bill passed the Senate.
Effectiveness
Provisions once approved apply to health benefit plans on or after Wed., Jan. 1, 2025.
May 2024 IOW LEG Governor Approval
On May 8, 2024, IOW LEG governor signed bill into law; applies from Jan. 1, 2025.
Regulators
IOW LEG
Entity Types
CNSM; Ins
Reference
Act, 5/8/2024; Bill, HF626, HF96-2023, 4/16/2024; IOW INS 514F;
