Plain English Breakdown
The source text mentions a state-mandated local program due to criminal penalties for willful violations, but does not detail how this affects specific agencies beyond reimbursement rules.
Rules for Changing Drug Lists and Approval Times
AB-2000 limits when health plans can change their drug lists, sets strict time limits for approving new drugs not on the list, and requires reporting on these changes.
What This Bill Does
- Prohibits health care service plans or insurers from changing a formulary during a plan year except in specified circumstances.
- Allows patients to stay on their current medication if it is safe, effective, and appropriately prescribed when the drug list changes mid-year.
- Requires plans to notify patients and doctors at least 90 days before implementing a change that forces a switch in medications.
- Mandates that plans report any formulary changes made during the year within 30 days of making them.
- Sets deadlines for approving non-listed drugs, requiring approval within 72 hours for standard requests or 24 hours if urgent circumstances exist.
- Requires the Department of Managed Health Care to publish an annual aggregated report on drug approval request data.
Who It Names or Affects
- Health care service plans and health insurers that offer prescription drug benefits.
- Patients enrolled in these insurance plans who take prescribed medications.
- Doctors and providers who prescribe drugs for patients.
- The Department of Managed Health Care and the Department of Insurance.
Terms To Know
- Formulary
- A list of prescription drugs that a health plan agrees to cover or pay for.
- Plan year
- The specific 12-month period during which an insurance policy is active and rules apply.
- Nonformulary drug
- A medication that is not currently on the health plan's approved list of covered drugs.
Limits and Unknowns
- The bill does not specify what exact circumstances allow a formulary change during the year.
- The specific amounts for administrative penalties are described as 'specified' but not listed in this text.
- The effective date of when these rules begin is not provided in the source material.