SENATE BILL 347

53rd legislature - STATE OF NEW MEXICO - first session, 2017

INTRODUCED BY

Jacob R. Candelaria

 

 

 

 

 

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING NEW SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE PUBLIC ASSISTANCE ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO ESTABLISH MINIMUM COVERAGE FOR CERTAIN PRESCRIPTION DRUGS.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs shall:

                (1) provide coverage for prescription contraceptive drugs or devices approved by the federal food and drug administration; and

                (2) reimburse for up to a twelve-month supply of a covered prescription contraceptive drug or device, whether dispensed on one or more occasions; provided that reimbursement for a covered prescription contraceptive drug or device prescribed to an enrollee for the first time may be limited to a three-month supply.

          B. Rules promulgated pursuant to Subsection A of this section shall not:

                (1) require reimbursement for a supply of a covered prescribed contraceptive drug or device that exceeds the supply that is medically necessary to provide contraception for an enrollee for the months remaining in the current policy year; or

                (2) require an enrollee to exhaust an existing supply of a covered prescribed contraceptive drug or device in order to be reimbursed for a different covered prescribed contraceptive drug or device for the months remaining in the policy year."

     SECTION 2. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] MEDICAL ASSISTANCE--REIMBURSEMENT FOR A SEVERAL-MONTH SUPPLY OF COVERED PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES.--

          A. In accordance with federal law, the secretary shall adopt and promulgate rules that allow a recipient to fill or refill a prescription for up to a twelve-month supply of a prescription contraceptive drug or device, whether dispensed on one or more occasions; provided that:

                (1) the recipient is eligible or presumptively eligible for medical assistance on the date that the prescription contraceptive drug or device is dispensed; and

                (2) reimbursement for a prescription contraceptive drug or device prescribed to a recipient for the first time may be limited to a three-month supply.

          B. Nothing in Subsection A of this section shall be construed to require a recipient to exhaust an existing supply of a prescribed contraceptive drug or device in order to be reimbursed for a different prescribed contraceptive drug or device."

     SECTION 3. Section 59A-22-42 NMSA 1978 (being Laws 2001, Chapter 14, Section 1, as amended) is amended to read:

     "59A-22-42. COVERAGE FOR PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES.--

          A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit shall:

                (1) provide coverage for prescription contraceptive drugs or devices approved by the federal food and drug administration; and

                (2) make reimbursement for up to a twelve-month supply of a prescription contraceptive drug or device, whether dispensed on one or more occasions; provided that reimbursement for a prescription contraceptive drug or device prescribed to an insured for the first time may be limited to a three-month supply.

          B. Nothing in Subsection A of this section shall be construed to:

                (1) require reimbursement for a supply of a prescribed contraceptive drug or device that exceeds the supply that is medically necessary to provide contraception for the insured for the months remaining in the current policy year; or

                (2) require an insured to exhaust an existing supply of a prescribed contraceptive drug or device in order to be reimbursed for a different prescribed contraceptive drug or device for the months remaining in the policy year.

          [B.] C. Coverage for federal food and drug administration-approved prescription contraceptive drugs or devices may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.

          [C.] D. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies.

          [D.] E. A religious entity purchasing individual or group health insurance coverage may elect to exclude prescription contraceptive drugs or devices from the health coverage purchased."

     SECTION 4. Section 59A-46-44 NMSA 1978 (being Laws 2001, Chapter 14, Section 3, as amended) is amended to read:

     "59A-46-44. COVERAGE FOR PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES.--

          A. Each individual and group health maintenance organization contract delivered or issued for delivery in this state that provides a prescription drug benefit shall:

                (1) provide coverage for prescription contraceptive drugs or devices approved by the federal food and drug administration; and

                (2) make reimbursement for up to a twelve-month supply of a prescription contraceptive drug or device, whether dispensed on one or more occasions; provided that reimbursement for a prescription contraceptive drug or device prescribed to an enrollee for the first time may be limited to a three-month supply.

          B. Nothing in Subsection A of this section shall be construed to:

                (1) require reimbursement for a supply of a prescribed contraceptive drug or device that exceeds the supply that is medically necessary to provide contraception for the enrollee for the months remaining in the current policy year; or

                (2) require an enrollee to exhaust an existing supply of a prescribed contraceptive drug or device in order to be reimbursed for a different prescribed contraceptive drug or device for the months remaining in the policy year.

          [B.] C. Coverage for federal food and drug administration-approved prescription contraceptive drugs or devices may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract.

          [C.] D. A religious entity purchasing individual or group health maintenance organization coverage may elect to exclude prescription contraceptive drugs or devices from the health coverage purchased."

     SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES.--

          A. A health care plan that provides a prescription drug benefit shall:

                (1) provide coverage for prescription contraceptive drugs or devices approved by the federal food and drug administration; and

                (2) make reimbursement for up to a twelve-month supply of a prescription contraceptive drug or device, whether dispensed on one or more occasions; provided that reimbursement for a prescription contraceptive drug or device prescribed to a subscriber for the first time may be limited to a three-month supply.

          B. Nothing in Subsection A of this section shall be construed to require:

                (1) reimbursement for a supply of a prescribed contraceptive drug or device that exceeds the supply that is medically necessary to provide contraception for the subscriber for the months remaining in the current policy year; or

                (2) a subscriber to exhaust an existing supply of a prescribed contraceptive drug or device in order to be reimbursed for a different prescribed contraceptive drug or device for the months remaining in the policy year.

          C. Coverage for federal food and drug administration-approved prescription contraceptive drugs or devices may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract.

          D. A religious entity purchasing individual or group health care plan coverage may elect to exclude prescription contraceptive drugs or devices from the health coverage purchased."

     SECTION 6. APPLICABILITY.--The provisions of this act apply to:

          A. group health coverage plans issued pursuant to the Health Care Purchasing Act on or after January 1, 2018;

          B. individual and group health insurance policies, health care plans and certificates of insurance delivered, or issued for delivery, in this state on or after January 1, 2018;

          C. individual and group health maintenance organization contracts delivered, or issued for delivery, in this state on or after January 1, 2018; and

          D. nonprofit health care plan contracts delivered, or issued for delivery, in this state on or after January 1, 2018.

- 8 -