Enrolled Bill Summary

            Senate Bill 1030 amends the Insurance Code to require a group health benefit plan that covers prescription drugs and that uses one or more drug formularies to disclose to enrollees in plain language certain information about those formularies including an explanation of what a formulary is and how to find out whether a specific drug is on a formulary. The plan must disclose, upon request, whether a specific drug is present on a drug formulary and notify the requestor that the drug's presence on the formulary does not guarantee that a provider will prescribe it for a particular illness. The act requires a plan that makes changes to its drug formulary to continue to make a prescription drug available at the contracted rate until the renewal date of the enrollee's plan. The act does not restrict a physician or other health professional from prescribing other medically appropriate drugs covered by the health plan. Additionally, the act provides that a refusal by a group health benefit plan to prescribe a medically necessary drug that is not contained in its drug formulary constitutes an adverse determination that may be appealed by the enrollee.