Plan Participants Must Be Notified of Adverse Formulary Changes

On July 1, 2018, HB 487 became law. This law provides that plans must provide plan participants with at least 60 days' notice of any adverse changes to formularies, unless prescription drugs are being removed from formularies because of safety concerns. A change is considered adverse if items are removed and plan participants affected by the change must be notified and given an ability to request exceptions to the formulary limitation. Plans must continue to honor existing prior authorizations until they expire, so long as plan participants continue to be covered under the same health plan and the drugs haven’t been removed from formularies because of safety concerns.

This bill becomes effective for plans issued or renewed on or after Jan. 1, 2019. This bill contains no new employer obligations, but employers with fully insured plans in Maine should review the new law to better understand the required changes.

HB 487 »