When people sign up for a health insurance plan they typically look to see if the doctors they currently visit are participating in the plan’s network and whether the prescription medications on which they depend are covered in the plan’s formulary. Current law does not permit the consumer to switch health plans until the next open enrollment period. But the health insurance company can reduce drug coverage at any time during the plan year. Non-medical switching of medications, can actually lead to more medical complications, expensive hospitalizations, emergency room use, and higher health care costs.

Legislation, Senate bill 5022, has been introduced that would fix this problem. It would prohibit dropping of drugs from health plan formularies or adding higher cost sharing during a plan year unless, in the case of movement of a drug to a higher cost-sharing tier, a generic equivalent for that drug is being added to the formulary. The legislation was introduced by Sen. Sue Serino, R-Hyde Park, has the support 36 patient advocacy, medical and civil rights organizations, and has 27 co-sponsors from both sides of the aisle.

Restricting mid-year formulary changes as this bill does introduces a measure of fairness. Consumers who pick a plan because it covers their drugs will have the assurance that the reason for their choice will remain in place for the entire year for which they are committed to that plan

The Assembly has passed this legislation four years in a row, but the Senate has yet to act. We need the support of Sen. Seward to get this legislation reported from the Insurance Committee to the floor so that it can be passed before the legislative session ends on June 20.

Heidi Siegfried


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