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Bill

A 5282

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals

2025 Regular Session Introduced by Scott Bendett and 7 co-sponsors

Bill A 5282 improves patient access to necessary medications by reducing barriers, allowing formulary exceptions, and streamlining prior authorizations and appeals processes.

REFERRED TO INSURANCE
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WeVote Research Nonpartisan
Bill Summary · A 5282

Summary of Bill A 5282

Bill Information

  • Bill Number: A 5282
  • Title: Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations, and external appeals
  • Status: Referred to Insurance
  • Introduced: February 12, 2025
  • Classification: Bill

Purpose and Intent

Bill A 5282 aims to enhance access to necessary medications for patients by ensuring that they can obtain appropriate drugs at reasonable prices. The bill addresses several key areas related to drug formularies, prior authorizations, and the appeals process for denied medication requests. The intent is to reduce barriers that patients face when trying to access essential medications, thereby improving overall health outcomes.

Key Provisions

The bill includes several significant provisions:

  1. Access to Appropriate Drugs:

    • Establishes guidelines to ensure that patients have access to necessary medications without undue financial burden.

  2. Formulary Exceptions:

    • Allows for exceptions to drug formularies, enabling patients to obtain medications that may not be listed but are deemed medically necessary by their healthcare providers.

  3. Standing Prior Authorizations:

    • Introduces provisions for standing prior authorizations, which would allow patients to receive ongoing medication without needing to reapply for authorization each time.

  4. External Appeals:

    • Provides a framework for external appeals when a patient's request for medication is denied by their insurance provider, ensuring that patients have a fair process to contest such decisions.

Who Would Be Affected

  • Patients: Individuals requiring medications will benefit from improved access and reduced barriers to obtaining necessary drugs.
  • Healthcare Providers: Physicians and healthcare professionals will have more flexibility in prescribing medications without the constraints of strict formulary limitations.
  • Insurance Companies: Insurers will need to adapt their policies and procedures to comply with the new requirements set forth in the bill.

Procedural Aspects

  • The bill was introduced on February 12, 2025, and has been referred to the Insurance committee for further consideration.
  • The legislative process will involve discussions, potential amendments, and voting within the committee before it can proceed to the full legislative body.

Related Bills

This bill is related to several prior-session bills that address similar issues:
- A 10215
- A 4521
- A 5046
- A 8067

These related bills may provide context or additional frameworks that inform the discussions surrounding A 5282.

Conclusion

Bill A 5282 represents a significant step toward improving access to medications for patients by addressing key barriers related to drug formularies and insurance authorizations. By ensuring that patients can obtain necessary medications at reasonable prices, the bill aims to enhance healthcare outcomes and patient satisfaction.

Compiled from official sources — confirm details with the bill’s official record.

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