00 Enrolled HB 218                                                                                                         
01 Prohibiting an insurer from using a drug formulary system of specialty tiers under certain                              
02 circumstances; relating to a reinsurance program reinsuring residents who are high risks; and                           
03 providing for an effective date.                                                                                        
04                           _______________                                                                               
05    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
06 to read:                                                                                                                
07       LEGISLATIVE FINDINGS FOR SECTION 3. The legislature finds that                                                    
08            (1)  cost sharing, deductibles, and coinsurance obligations for certain drugs are                            
09 becoming prohibitively expensive for persons trying to overcome serious and often life-                                 
10 threatening diseases and conditions, such as cancer, multiple sclerosis, rheumatoid arthritis,                          
11 hepatitis C, hemophilia, and psoriasis, and that drugs for treatment of those illnesses and                             
12 conditions are typically new, produced in lesser quantities than other drugs, and not available                         
13 as less expensive brand-name or generic prescription drugs;                                                             
14            (2)  some health insurance plans and policies in other states have established                               
01 unique categories or specialty tiers for certain drugs, under which patients are required to pay                        
02 a higher percentage of the cost of high-priced prescription drugs rather than the traditional                           
03 copayment amounts for generic, preferred brand, and nonpreferred brand prescription drugs;                              
04 as a result, patients covered under plans in states that allow specialty tiers pay excessively                          
05 high amounts for drugs that are critical for their treatment;                                                           
06            (3)  helping to ensure that patients are well informed about potential expenses                              
07 resulting from cost sharing, deductibles, and coinsurance obligations that exceed insurance                             
08 coverage for prescription drugs or equivalents is in the public interest;                                               
09            (4)  the extraordinary disparity in cost sharing, deductible, and coinsurance                                
10 burdens imposed by an insurer's use of unique categories or specialty tiers for patients whose                          
11 life and health depend on certain prescription drugs can place serious hardships on individuals                         
12 based on their diseases or conditions.                                                                                  
13    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
14 read:                                                                                                                   
15       LEGISLATIVE INTENT. Section 3 of this Act intends to provide patients timely                                      
16 information relating to the cost of prescription drugs essential for the treatment of cancer,                           
17 multiple sclerosis, rheumatoid arthritis, hepatitis C, hemophilia, psoriasis, and other diseases                        
18 or conditions.                                                                                                          
19    * Sec. 3. AS 21.42 is amended by adding a new section to read:                                                     
20            Sec. 21.42.420. Coverage for prescription drugs; specialty drug tiers                                      
21       prohibited. A health care insurer that offers, issues, delivers, or renews a health care                        
22       insurance plan in the individual or group market in the state that provides coverage for                          
23       prescription drugs for which cost sharing, deductibles, or copayment obligations are                              
24       determined by unique categories or specialty tiers may impose cost sharing,                                       
25       deductibles, or copayment obligations for a unique category or specialty tier                                     
26       prescription drug that exceed the dollar amount of cost sharing, deductibles, or                                  
27       copayment obligations, as applicable, for a nonpreferred brand drug or the drug's                                 
28       equivalent, but only if the insurer notifies the insured of the cost sharing, deductible,                         
29       or copayment terms applicable to unique categories or specialty tiers at least 90 days                            
30       before the terms apply.                                                                                           
31    * Sec. 4. AS 21.55.220(c) is amended to read:                                                                      
01            (c)  Each member of the association shall share the losses due to claims                                     
02       expenses of the state plans issued or approved for issuance by the association; each                          
03       member of the association shall share the losses of a reinsurance program                                     
04       established by regulations adopted under AS 21.55.400 reinsuring residents who                                
05       are high risks; [,] and each member of the association shall share in the operating                       
06       and administrative expenses incurred or estimated to be incurred by the association                               
07       incident to the conduct of its affairs. Claims expenses of the state plan that exceed the                         
08       premium payments allocated to the payment of benefits shall be the liability of the                               
09       members. Each member shall share in the claims expense of the state plans, the                                
10       [AND] operating and administrative expenses of the association, and the losses of a                           
11       reinsurance program established by regulations adopted under AS 21.55.400                                     
12       reinsuring residents who are high risks, in an amount equal to the ratio of the                               
13       member's total major medical premiums, received from or on behalf of state residents,                             
14       as divided by the total major medical premiums received by all members from or on                                 
15       behalf of state residents, as determined by the director.                                                         
16    * Sec. 5. AS 21.55.400 is amended to read:                                                                         
17            Sec. 21.55.400. Duties of director. The director may                                                       
18                 (1)  approve the selection of the plan administrator by the association                                 
19       and approve the association's contract with the plan administrator, including the                                 
20       coverages and premiums to be charged;                                                                             
21                 (2)  contract with the federal government or another unit of government                                 
22       to ensure coordination of the state plans with other governmental assistance programs;                            
23                 (3)  undertake, directly or through contracts with other persons, studies                       
24       or demonstration programs to develop awareness of the benefits of this chapter; and                               
25                 (4)  formulate general policy and adopt regulations, including                                      
26       regulations establishing a reinsurance program reinsuring residents who are high                              
27       risks, that are reasonably necessary to administer this chapter.                                              
28    * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to                          
29 read:                                                                                                                   
30       APPLICABILITY. AS 21.42.420, added by sec. 3 of this Act, applies to a health                                     
31 insurance plan offered, issued for delivery, delivered, or renewed on or after the effective date                       
01 of this Act.                                                                                                            
02    * Sec. 7. This Act takes effect January 1, 2013.