More Mandated Health Benefits Laws On The Way From The States

The states seem to have picked up the pace in enacting mandated health benefits laws. Here’s a summary of some of the recent activity.

Maine. Effective Jan. 1, 2015, health insurance carriers that provide coverage for cancer chemotherapy treatment will be required to provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancer that is equivalent to the coverage provided for intravenously administered or injected anticancer medications (Ch. 449 (S. 217), L. 2013).

Mississippi. Effective July 1, 2014, outpatient mental illness coverage must be provided on parity with inpatient and partial hospitalization mental illness coverage (S. 2331, L. 2014).

Missouri. Effective Jan. 1, 2015, any health benefit plan that provides coverage and benefits for cancer treatment shall provide coverage of prescribed orally administered anticancer medications on a basis no less favorable than intravenously administered or injected anticancer medications (S. 668, L. 2014).

New Hampshire. Effective April 21, 2014, no health benefit plan that provides prescription drug benefits and establishes the specific sequence in which prescription drugs for a medical condition are to be prescribed shall require failure on the same medication on more than one occasion for patients continuously enrolled in the plan (Ch. 2 (S. 92), L. 2013).

Oregon. Oregon has made significant changes to its law relating to health insurance coverage requirements for colorectal cancer screening (Ch. 9 (H. 4085), L. 2014).

South Dakota. Any qualified health plan issued on or after Jan. 1, 2015, that offers coverage for professional audiology services shall include coverage for medically necessary physician services appropriate for the treatment of hearing impairment to a person under the age of 19 (S. 122, L. 2014).

Virginia. The state has enacted a law requiring any health insurer, corporation providing group accident and sickness subscription contracts, or HMO that applies a formulary to prescription drug benefits provided under its policy, contract, or plan to provide prior written notice to each insured of a formulary modification that results in the movement of the drug to a tier with a higher cost (Ch. 272 (H. 308) and Ch. 297 (S. 201), L. 2014).

Washington. Each health benefit plan issued or renewed after Dec. 31, 2015, must offer benefits or coverage for medically necessary elemental formula when a licensed physician or other health care provider with prescriptive authority: (a) diagnoses a patient with an eosinophilic gastrointestinal associated disorder; and (b) orders and supervises the use of the formula (H. 2153, L. 2013).

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