WEST virginia legislature

2018 regular session

Committee Substitute

for

Senate Bill 473

By Senators Takubo, Ojeda, Stollings, Baldwin, and Cline

[Originating in the Committee on Health and Human Resources; Reported on February 9, 2018]

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-7b; to amend said code by adding thereto a new section, designated §9-5-20a; to amend said code by adding thereto a new section, designated §33-15-4p; to amend said code by adding thereto a new section, designated §33-16-3bb; to amend said code by adding thereto a new section, designated §33-24-7q; to amend said code by adding thereto a new section, designated §33-25-8n; and to amend said code by adding thereto a new section, designated §33-25A-8p, all relating to requiring insurance coverage for the prescription drug Varenicline; prohibiting insurance plans from requiring use of other methods or prescriptions prior to coverage for Varenicline; placing similar requirements on the Public Employees Insurance Agency; placing similar requirements upon the state Medicaid program; allowing a generic alternative, should one become available; and allowing health care providers to provide other medically appropriate prescription drugs.

Be it enacted by the Legislature of West Virginia:

CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE, AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.

§5-16-7b.  Required coverage for smoking cessation drug.

(a) The plan shall provide for the coverage of the prescription drug Varenicline for smoking cessation without placing upon the participant or beneficiary restrictions by the health plan insurer or utilization organization to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the participant or beneficiary’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness.

(b) This section may not be construed to prevent:

(1) A health plan issuer or utilization review organization from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

CHAPTER 9. HUMAN SERVICES.

ARTICLE 5. MISCELLANEOUS PROVISIONS.

§9-5-20a.  Required coverage for smoking cessation drug.

(a) Any enrollee in the state Medicaid program who is eligible for services and who has a prescription from a prescriber licensed pursuant to chapter 30 of this code shall receive coverage for the prescription drug Varenicline for smoking cessation without placing upon the enrollee restrictions to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the enrollee’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness. 

(b) This section may not be construed to prevent:

(1) The state Medicaid program from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

chapter 33.  insurance.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4p.  Required coverage for smoking cessation drug.

(a) A contract, plan, or agreement issued by an insurer pursuant to this article shall provide for the coverage of the prescription drug Varenicline for smoking cessation without placing upon the participant or beneficiary restrictions by the insurer or utilization organization to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the participant or beneficiary’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness. 

(b) This section may not be construed to prevent:

(1) An issuer or utilization review organization from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3bb.  Required coverage for smoking cessation drug.

(a) A contract, plan, or agreement issued by an insurer pursuant to this article shall provide for the coverage of the prescription drug Varenicline for smoking cessation without placing upon the participant or beneficiary restrictions by the insurer or utilization organization to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the participant or beneficiary’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness. 

(b) This section may not be construed to prevent:

(1) An issuer or utilization review organization from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS, AND HEALTH SERVICE CORPORATIONS.

§33-24-7q.  Required coverage for smoking cessation drug.

(a) A contract, plan, or agreement issued by an insurer pursuant to this article shall provide for the coverage of the prescription drug Varenicline for smoking cessation without placing upon the participant or beneficiary restrictions by the insurer or utilization organization to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the participant or beneficiary’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness. 

(b) This section may not be construed to prevent:

(1) An issuer or utilization review organization from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-8n.  Required coverage for smoking cessation drug.

(a) A contract, plan, or agreement issued by an insurer pursuant to this article shall provide for the coverage of the prescription drug Varenicline for smoking cessation without placing upon the participant or beneficiary restrictions by the insurer or utilization organization to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the participant or beneficiary’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness.

(b) This section may not be construed to prevent:

(1) An issuer or utilization review organization from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8p.  Required coverage for smoking cessation drug.

(a) A contract, plan, or agreement issued by an insurer pursuant to this article shall provide for the coverage of the prescription drug Varenicline for smoking cessation without placing upon the participant or beneficiary restrictions by the insurer or utilization organization to have attempted to use other methods of smoking cessation or prescription drugs if in the medical judgment of the participant or beneficiary’s health care provider the use of Varenicline is the best medical alternative for success and is in the best interest of the patient based upon medical appropriateness. 

(b) This section may not be construed to prevent:

(1) An issuer or utilization review organization from requiring a patient to try a generic equivalent should one become available prior to providing coverage for Varenicline.

(2) A health care provider from prescribing any other prescription drug that is determined to be medically appropriate.

NOTE: The purpose of this bill is to require insurance coverage for the prescription drug Varenicline. The bill prohibits insurance plans from requiring use of other methods or prescriptions prior to coverage for Varenicline. The bill places similar requirements on the Public Employees Insurance Agency. The bill places similar requirements upon the state Medicaid program. The bill allows a generic alternative should one become available and allows health care providers to provide other medically appropriate prescription drugs.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.