00                            HOUSE BILL NO. 218                                                                          
01 "An Act prohibiting an insurer from using a drug formulary system of specialty tiers                                    
02 under certain circumstances."                                                                                           
03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
04    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
05 to read:                                                                                                                
06       LEGISLATIVE FINDINGS. The legislature finds that                                                                  
07            (1)  cost sharing, deductibles, and coinsurance obligations for certain drugs are                            
08 becoming prohibitively expensive for persons trying to overcome serious and often life-                                 
09 threatening diseases and conditions, such as cancer, multiple sclerosis, rheumatoid arthritis,                          
10 hepatitis C, hemophilia, and psoriasis, and that drugs for treatment of those illnesses and                             
11 conditions are typically new, produced in lesser quantities than other drugs, and not available                         
12 as less expensive brand-name or generic prescription drugs;                                                             
13            (2)  some health insurance plans and policies in other states have established                               
14 unique categories or specialty tiers for certain drugs, under which patients are required to pay                        

01 a higher percentage of the cost of high-priced prescription drugs rather than the traditional                           
02 copayment amounts for generic, preferred brand, and nonpreferred brand prescription drugs;                              
03 as a result, patients covered under plans in states that allow specialty tiers pay excessively                          
04 high amounts for drugs that are critical for their treatment;                                                           
05            (3)  helping to ensure that patients are well informed about potential expenses                              
06 resulting from cost sharing, deductibles, and coinsurance obligations that exceed insurance                             
07 coverage for prescription drugs or equivalents is in the public interest;                                               
08            (4)  the extraordinary disparity in cost sharing, deductible, and coinsurance                                
09 burdens imposed by an insurer's use of unique categories or specialty tiers for patients whose                          
10 life and health depend on certain prescription drugs can place serious hardships on individuals                         
11 based on their diseases or conditions.                                                                                  
12    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
13 read:                                                                                                                   
14       LEGISLATIVE INTENT. This Act intends to provide patients timely information                                       
15 relating to the cost of prescription drugs essential for the treatment of cancer, multiple                              
16 sclerosis, rheumatoid arthritis, hepatitis C, hemophilia, psoriasis, and other diseases or                              
17 conditions.                                                                                                             
18    * Sec. 3. AS 21.42 is amended by adding a new section to read:                                                     
19            Sec. 21.42.420. Coverage for prescription drugs; specialty drug tiers                                      
20       prohibited. A health care insurer that offers, issues, delivers, or renews a health care                        
21       insurance plan in the individual or group market in the state that provides coverage for                          
22       prescription drugs for which cost sharing, deductibles, or copayment obligations are                              
23       determined by unique categories or specialty tiers may impose cost sharing,                                       
24       deductibles, or copayment obligations for a unique category or specialty tier                                     
25       prescription drug that exceed the dollar amount of cost sharing, deductibles, or                                  
26       copayment obligations, as applicable, for a nonpreferred brand drug or the drug's                                 
27       equivalent, but only if the insurer notifies the insured of the cost sharing, deductible,                         
28       or copayment terms applicable to unique categories or specialty tiers at least 90 days                            
29       before the terms apply.                                                                                           
30    * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to                          
31 read:                                                                                                                   

01       APPLICABILITY. AS 21.42.420, added by sec. 3 of this Act, applies to a health                                     
02 insurance plan offered, issued for delivery, delivered, or renewed on or after the effective date                       
03 of this Act.