Nonmedical Switching Enacted Laws



Requires health plans to continue serving their enrollees through the duration of the plan year if the health plan terminates its contract. The enrollee must meet any of the following conditions:
-They were receiving services from a terminated provider at the time of termination;
-The enrollee has an acute condition;
-The enrollee has a serious chronic condition;
-The enrollee is pregnant;
-The enrollee has a terminal condition;
-The enrollee is a child between 12-36 months;
-The enrollee was scheduled for surgery within 180 days of the contract termination.



Requires health plans to provide continuity of care for their enrollees if their provider leaves the insurance network. Care shall be continued for 90 days after the notice of termination is given to the enrollee.

Prohibits a health plan from rescinding coverage for a medication in the middle of a plan year unless it provides 60-days of advanced notice to the enrollees who are currently receiving that medication and providers who are prescribing it. Allows providers to override the coverage rescission by attesting to the medical necessity of the medication.



Requires health plans to provide coverage of the medications listed on their formulary through the duration of the plan year, regardless of whether coverage was rescinded in the middle of the plan year.



Requries health plans to create a process for providers to apply for an exception if medication coverage is adversely affected and a nonformulary alternative is medically indicated. Requires health plans to provide enrollees with 60-days notice if there is an adverse change to their medication coverage. Requires health plans to honor prior authorization approvals until they expire, even if coverage for the authorized medication is adversely affected.



Prohibits health plans from rescinding formulary coverage in the middle of the plan year except for concerns about product safety. Prohibits health plans from moving a medication to a higher cost-sharing tier unless they do so in combination with including coverage for a generic alternative at an equal or lower tier than the product was originally covered at.



Requires health plans to cover all medications to treat chronic, disabling, or life-threatening illnesses otherwise covered under by the plan. Permits health plans to only change medication coverage during coverage renewal. Requires health plans to provide enrollees with a written notice 60 days in advance of any formualry coverage change.