Revision: Jan. 13, 2016, midnight
\t \t\tSB 401-FN - AS INTRODUCED
2016 SESSION
\t16-2795
\t01/10
SENATE BILL\t401-FN
AN ACT\trelative to insurance coverage for prescription eye drops.
SPONSORS:\tSen. Carson, Dist 14; Sen. Stiles, Dist 24; Sen. Fuller Clark, Dist 21; Rep. Sherman, Rock. 24; Rep. Fothergill, Coos 1
COMMITTEE:\tCommerce
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ANALYSIS
\tThis bill provides for insurance coverage for early refills of prescription eye drops.
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Explanation:\tMatter added to current law appears in bold italics.
\t\tMatter removed from current law appears [in brackets and struckthrough.]
\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2795
\t01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trelative to insurance coverage for prescription eye drops.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 New Section; Accident and Health Insurance; Individual; Coverage for Early Refills of Prescription Eye Drops. Amend RSA 415 by inserting after section 6-t the following new section:
\t415:6-u Coverage for Early Refills of Prescription Eye Drops.
\t\tI. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for one early refill of a prescription for eye drops if the following criteria are met:
\t\t\t(a) For prescription eye drops dispensed as a 30-day supply, the enrollee requests the refill fewer than 30 days after the later of the following dates:
\t\t\t\t(1) The date the original prescription was dispensed to the enrollee; or
\t\t\t\t(2) The date that the most recent refill of the prescription was dispensed to the enrollee;
\t\t\t(b) For prescription eye drops dispensed as a 90-day supply, the enrollee requests the refill fewer than 90 days after the later of the following dates:
\t\t\t\t(1) The date the original prescription was dispensed to the enrollee; or
\t\t\t\t(2) The date that the most recent refill of the prescription was dispensed to the enrollee;
\t\t\t(c) The prescribing health care provider indicated on the original prescription that a specific number of refills are authorized;
\t\t\t(d) The refill requested by the enrollee does not exceed the number of refills indicated on the original prescription;
\t\t\t(e) The prescription has not been refilled more than once during the 30-day or 90-day period prior to the request for an early refill; and
\t\t\t(f) The prescription eye drops are a covered benefit under the enrollee’s health plan.
\t\tII. Benefits provided under this section shall not be subject to any greater copayment, deductible, or coinsurance than any other similar benefits provided by the insurer.
\t2 New Section; Accident and Health Insurance; Group; Coverage for Early Refills of Prescription Eye Drops. Amend RSA 415 by inserting after section 18-y the following new section:
\t415:18-z Coverage for Early Refills of Prescription Eye Drops. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for one early refill of a prescription for eye drops if the following criteria are met:
\t\t\t(a) For prescription eye drops dispensed as a 30-day supply, the enrollee requests the refill fewer than 30 days after the later of the following dates:
\t\t\t\t(1) The date the original prescription was dispensed to the enrollee; or
\t\t\t\t(2) The date that the most recent refill of the prescription was dispensed to the enrollee;
\t\t\t(b) For prescription eye drops dispensed as a 90-day supply, the enrollee requests the refill fewer than 90 days after the later of the following dates:
\t\t\t\t(1) The date the original prescription was dispensed to the enrollee; or
\t\t\t\t(2) The date that the most recent refill of the prescription was dispensed to the enrollee;
\t\t\t(c) The prescribing health care provider indicated on the original prescription that a specific number of refills are authorized;
\t\t\t(d) The refill requested by the enrollee does not exceed the number of refills indicated on the original prescription;
\t\t\t(e) The prescription has not been refilled more than once during the 30-day or 90-day period prior to the request for an early refill; and
\t\t\t(f) The prescription eye drops are a covered benefit under the enrollee’s health plan.
\t\tII. Benefits provided under this section shall not be subject to any greater copayment, deductible, or coinsurance than any other similar benefits provided by the insurer.
\t3 Health Services Corporations; Coverage for Early Refills of Prescription Eye Drops; Effective January 1, 2017. Amend RSA 420-A:2 to read as follows:
\t420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-s, RSA 415:6-t, RSA 415:6-u, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-x, RSA 415:18-y, RSA 415:18-z, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
\t4 Health Services Corporations; Coverage for Early Refills of Prescription Eye Drops; Effective October 1, 2017. RSA 420-A:2 is repealed and reenacted to read as follows:
\t420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
\t5 Health Services Corporations; Coverage for Early Refills of Prescription Eye Drops; Effective January 1, 2021. RSA 420-A:2 is repealed and reenacted to read as follows:
\t420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-u, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-z, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
\t6 Health Maintenance Organizations; Coverage for Early Refills of Prescription Eye Drops; Effective January 1, 2017. Amend RSA 420-B:3, III to read as follows:
\t\tIII. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-s, RSA 415:6-t, RSA 415:6-u, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-x, RSA 415:18-y, RSA 415:18-z, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
\t7 Health Maintenance Organizations; Coverage for Early Refills of Prescription Eye Drops; Effective October 1, 2017. RSA 420-B:20, III is repealed and reenacted to read as follows:
\t\tIII. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
\t8 Health Maintenance Organizations; Coverage for Early Refills of Prescription Eye Drops; Effective January 1, 2021. RSA 420-B:3, III is repealed and reenacted to read as follows:
\t\tIII. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-u, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-z, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
\t\tI. Sections 4 and 7 of this act shall take effect October 1, 2017 at 12:02 a.m.
\t\tII. Sections 5 and 8 of this act shall take effect January 1, 2021 at 12:01 a.m.
\t\tIII. The remainder of this shall take effect 60 days after its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2795
\t\t\t\t\t\t\t\t\t\t\t12/11/15
SB 401-FN- FISCAL NOTE
AN ACT\trelative to insurance coverage for prescription eye drops.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as introduced, may increase state expenditures by an indeterminable amount in FY 2017 and each year thereafter. There will be no impact state, county or local revenue or on county or local expenditures.
METHODOLOGY:
The Department of Health and Human Services indicates this bill amends an insurance statute to require insurance carriers cover one early refill of prescription eye drops in certain instances. This change would not be applicable to Medicaid services delivered via fee-for service. The Department states it is not clear if the Department of Insurance would consider RSA 415 as applying to Medicaid Managed Care Organizations (MCOs), but assumes for the fiscal note that it would apply. The Department is not able to calculate the fiscal impact because it does not have information on how many people might use the early refill or which drops would be prescribed, but provides the following additional information:
•\tThe Medicaid program requires 80% usage of eye drops prior to refill. The number of drops per bottle is not an exact and eye drops are difficult to measure.
•\tThe bill could result in a coverage gap if a consumer uses all refills prior to obtaining another prescription.
•\tPrescription eye drops costs vary depending on the medication.
•\tCosts to the Medicaid program could increase. A consumer who normally receives 12 bottles per year could potentially use more than 12 bottles per year due to early refill. These costs are paid 50% with state funds and 50% with federal Medicaid matching funds.
The Insurance Department states the mandate to require insurance carriers cover one early refill of prescription eye drops in certain instances will not impact insurance claims, the insurance premium tax base, or premium tax revenue to the general fund.
The Department of Administrative Services states this bill would have no fiscal impact on the state employee and retiree health benefit program. The Department indicates the bill would apply to insurance carriers, but not the state employee and retiree health benefit program which is self-funded and not subject to this insurance law coverage mandate.