“It will do monumental things for people who get covered and can go to the doctor and get prescriptions filled and have some peace of mind that they can take…
Pair of consumer protection bills introduced in House
Two bills that propose stronger protections for consumers in health insurance were introduced last week by a group of House lawmakers led by Representative David Knight. We are encouraged by the introduction of both bills which aim to provide consumers with increased transparency and enhanced financial protections, along with heightened accountability on the part of health insurers and pharmacy benefit managers. We will monitor and weigh in on the bills as they progress through the legislative process.
HB 872: Provider network transparency
HB 872 requires insurance companies to be more transparent about the structure of and changes within their provider networks, beginning with a provision that requires insurers to make publicly available a plain language description of their provider network standards on their website among other provisions. Importantly, the bill also stipulates that if an insurer advertises a physician as being in a plan’s provider network as a consumer enrolls in an insurance plan, the insurer is required to cover the health care services received from that provider at an in-network rate during the entire contract year. That means that a consumer may select a plan during open enrollment that includes their preferred provider and would be able to receive services at an in-network rate for the entire plan year regardless of changes to the provider’s participation status.
HB 873: Prescription drug formulary & prior authorization transparency
HB 873, titled the Prescription Drug Benefits Freedom of Information and Consumer Protection Act, proposes to improve the consistency and clarity of prescription drug formularies and prior authorization processes. The bill requires that insurers provide an easy-to-find, accurate, and updated formulary list on their website and requires the Insurance Commissioner to create rules about the format and information within the formulary so that consumers can more easily understand what prescriptions are covered under their insurance plan, the cost-sharing associated with the drug, and any prior authorization required to gain access to the prescription. The legislation also requires that a single, standard prior authorization form be developed that would apply to all insurers and pharmacy benefit managers regulated in Georgia to allow consumers and providers to more easily request access to higher cost and more restricted health services and prescriptions. The standard form would be developed by an advisory committee made up of an equal number of consumers, physicians, pharmacists, insurers, insurance agents, and pharmacy benefit managers.
Both chambers busy with health care legislation
House Insurance Committee approves HB 678
The House Insurance Committee, chaired by Representative Richard Smith, considered and approved HB 678 last week. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and insurers about the consumer’s provider network. HB 678 is expected to receive a vote by the full House today. (For a more detailed summary of HB 678, check out last week’s legislative update.)
Senate approves SB 352 and SB 357
Two pieces of legislation resulting from the Health Care Reform Task Force were approved by the Senate this week. Both SB 352, which establishes the Commission on Substance Abuse and Recovery and creates a director position to lead the commission, and SB 357, which establishes the Health Coordination and Innovation Council among other actions, received strong support from legislators. The bills will now move to the House for its consideration. (For more information on both bills, read the January 29th legislative update.)