An Act to create 609.835 and 632.895 (16g) of the statutes; Relating to: cost-sharing caps on prescription drugs and medical supplies to treat asthma under health insurance policies and plans. (FE)
Impact
Under SB251, health plans would be limited in how much they can charge individuals for asthma-related prescriptions, ensuring that no enrollee pays more than $25 for a one-month supply of any prescribed asthma medication and no more than $50 for all related supplies each month. Additionally, the bill specifies that these costs cannot increase based on the number of conditions for which an individual is treated and explicitly states that there should be no deductible related to this coverage. This aspect of the bill aims to alleviate the financial burden on individuals who require ongoing treatment for asthma, potentially leading to improved health outcomes.
Summary
Senate Bill 251 proposes to create new sections of the Wisconsin statutes that mandate coverage for prescription drugs and related medical supplies necessary for the treatment of asthma. The legislation requires health insurance policies, including those from limited service health organizations and defined network plans, to cover these necessary medications and supplies, which encompass asthma inhalers and other items essential for effective asthma management. One of the bill's primary objectives is to improve access to essential asthma treatments by regulating cost-sharing requirements imposed by insurers.
Contention
While the bill enjoys support from various health advocacy groups who see it as a necessary step toward improving asthma care, there may be concerns regarding its implications for health insurance providers. Critics may argue that introducing cost-sharing caps represents a mandate they would be forced to implement, which could lead to increased overall insurance premiums. Additionally, there is a possibility that the bill may be seen as a precursor to broader discussions about healthcare mandates in the state, leading to contention regarding the government’s role in regulating insurance practices.
Fiscal_implications
The bill includes a provision indicating that it might require a social and financial impact report, considering the implications for health insurance mandates. This report, as suggested in the bill, would help to analyze how the proposed changes impact both consumers and insurers within the state. It highlights the potential need for balancing enhanced healthcare access with the economic realities faced by insurance companies and their customers.
Crossfiled
An Act to create 609.835 and 632.895 (16g) of the statutes; Relating to: cost-sharing caps on prescription drugs and medical supplies to treat asthma under health insurance policies and plans. (FE)
An Act to amend the Code of Virginia by adding a section numbered 38.2-3407.15:9, relating to health insurance; limit on cost-sharing payments for prescription drugs under certain plans.
Prescriptions for testosterone not allowed to be transmitted or reported within the prescription drug monitoring database and removes from the records all existing information concerning prior testosterone prescriptions.
Prescriptions for testosterone not allowed to be transmitted or reported within the prescription drug monitoring database and removes from the records all existing information concerning prior testosterone prescriptions.
Increases the maximum fill for non-opioid, non-narcotic controlled substances found in schedule II, so that a sixty-day (60) supply may be dispensed at any one time.
Increases the maximum fill for non-opioid, non-narcotic controlled substances found in schedule II, so that a ninety-day (90) supply may be dispensed at any one time.