Mandated Coverage for Biomarker Testing

Recently, Gov. Huckabee Sanders signed several healthcare bills into law.

Act 333 (previously HB 1481) requires that prescription drug rebates be shared with enrollees. Specifically, under Act 333, an enrollee’s cost-sharing for a prescription drug at the point of sale must be based on a price that is reduced by all rebates received, or to be received, in connection with the dispensing or administration of the drug. Act 333 is directed at both insurers and pharmacy benefit managers and requires pharmacy benefit managers to submit an annual attestation of compliance to the state’s Insurance Commissioner.

Act 480 (previously HB 1261) requires that on and after January 1, 2024, a healthcare insurer that offers, issues, or renews a health benefit plan in the state must provide coverage:

1. For an ambulance service to:
   • Treat an enrollee in place if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
   • Triage or triage and transport an enrollee to an alternative destination (e.g., urgent care center, physician’s office or medical clinic) if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
2. For an encounter between an ambulance service and enrollee that results in no transport of the enrollee if:
   • The enrollee declines to be transported against medical advice; and
   • The ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint.

The coverage applies if the initiation of the ambulance service treatment is because of a 911 call and is subject to health benefit plan deductibles or copayments, among other requirements.

Group health plan sponsors may want to be aware of these new laws and should contact their carrier or pharmacy benefit manager, as applicable, for further information.

HB 1481 »
HB 1261 »