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7 LONG TITLE
8 General Description:
9 This bill modifies provisions related to health benefit plans and prescription drugs.
10 Highlighted Provisions:
11 This bill:
12 ▸ defines terms; and
13 ▸ requires health benefit plans to create certain procedures related to prescription
14 drugs.
15 Money Appropriated in this Bill:
16 None
17 Other Special Clauses:
18 None
19 Utah Code Sections Affected:
20 ENACTS:
21 31A-22-660, Utah Code Annotated 1953
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23 Be it enacted by the Legislature of the state of Utah:
24 Section 1. Section 31A-22-660 is enacted to read:
25 31A-22-660. Health benefit plan procedures related to prescription drugs.
26 (1) As used in this section, "long-term drug" means an enrollee's prescription drug
27 where the prescription has been active for at least 180 days with the health benefit plan.
28 (2) (a) Except as provided in Subsection (2)(b), before a health benefit plan requires an
29 enrollee to change from a prescribed long-term drug to another drug, the health benefit plan
30 shall:
31 (i) at least 30 days before the day on which the health benefit plan will require the
32 enrollee to change from the long-term drug to another drug, provide notice that the health
33 benefit plan will require the individual to change to another drug; and
34 (ii) provide a justification for the change upon request.
35 (b) Subsection (2)(a) does not apply if:
36 (i) the change requires the individual to try a generic or a biosimilar of the long-term
37 drug; or
38 (ii) the long-term drug is not on the health benefit plan's formulary.
39 (3) A health benefit plan shall provide an enrollee a justification as to why an enrollee
40 must try a certain drug before a health benefit plan will cover a different prescribed drug.
41 (4) This section does not apply to a drug that is provided under the health benefit plan's
42 medical benefit.
43 Section 2. Effective date.
44 This bill takes effect on May 1, 2024.