Bills of interest:
LD 107: An Act to Require Health Insurance Coverage for Biomarker Testing
This bill requires insurance coverage, including coverage in the MaineCare program, for
biomarker testing.
This bill had a divided vote, with all committee members but one voting OTP as
amended. The amendment is not available currently.
LD 163: An Act to Require Health Insurance Coverage for Federally Approved Nonprescription Oral Hormonal Contraceptives and Nonprescription Emergency Contraceptives
This bill expands the requirements in current law for coverage of contraceptives to
include nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives approved by the federal Food and Drug Administration. The bill provides that a prescription is not required for insurance coverage for nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives and requires insurers to establish mechanisms to ensure that an enrollee who purchases a nonprescription oral hormonal contraceptive or nonprescription emergency contraceptive at a pharmacy has the option to make the purchase pursuant to a standing order issued for billing purposes without a payment required at the point of sale or to make the purchase with a payment at the point of sale and submit a claim for reimbursement to the insurer. The requirements apply beginning January 1, 2026. The bill requires health insurance carriers to notify enrollees, at least annually, of the coverage requirements for contraceptive supplies and the procedures an enrollee must follow to access coverage for nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives at a pharmacy without an out-of-pocket cost at the point of sale or by submitting a claim for reimbursement. The bill also authorizes the Department of Professional and Financial Regulation, Bureau of Insurance to adopt rules to implement the provisions and also requires the bureau to monitor implementation by health insurance carriers and to report to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters no later than November 4, 2026.
LD 178: An Act Regarding Coverage for Step Therapy for Advanced Metastatic Cancer
This bill prohibits a health plan that provides coverage for advanced metastatic cancer
and associated conditions from requiring an enrollee to fail to successfully respond to a different drug or prove a history of failure of a different drug before providing coverage of a prescription drug approved by the United States Food and Drug Administration.
This bill was voted out of committee as OTP as amended. The amendment is not
available currently.
LD 270: Resolve, Regarding Legislative Review of Portions of Chapter 850: Health Plan Accountability, a Major Substantive Rule of the Department of Professional and Financial Regulation, Bureau of Insurance
This Resolve would implement changes from last session that primarily impact
Pharmacy Benefit Managers.
LD 378: An Act to Strengthen the Health Care System in Maine
This bill is still a concept draft, so no language was filed. As soon as Senator Bailey files
language, we will update this section and advise as to whether testimony is required.
LD 519: An Act to Remove the Requirement That Individual and Small Group Health Plans Be Offered Through a Pooled Market and to Eliminate the Provision of Law Establishing a Pooled Market for Those Plans
This bill repeals the provisions of the Maine Insurance Code that establish a pooled
market for individual and small group health plans, removing the requirement that those types of plans must be offered through a pooled market. The bill also eliminates related provisions that require the Maine Guaranteed Access Reinsurance Association to operate a retrospective reinsurance program providing coverage to member insurers for all individual and small group health plans issued in any plan year in which a pooled market is operating.
This bill was introduced last year and voted ONTP by the committee. Being a Republican bill, it will probably be turned down again.
LD 520: An Act to Ensure Choices in Health Insurance Markets by Modifying the Provisions of Law Governing Clear Choice Design Health Plans
This bill amends the provisions of the Maine Insurance Code related to pooled market
and clear choice design. The bill eliminates the requirement that health insurance carriers offering individual health plans must make those plans available to all eligible small employers within the plan's approved service area. It also eliminates the requirement that health insurance carriers offering small group health plans make those plans available to all eligible individuals residing within the plan's approved service area. The bill eliminates requirements related to premium rate adjustments for health plans that are issued on other than a calendar year basis.
The bill requires the Superintendent of Insurance to develop separate clear choice designs for individual health plans and small group health plans and requires that on January 31st of each year, the superintendent must release the proposed clear choice designs to be used in the following plan year for review and comment by stakeholders. The bill modifies provisions related to alternative designs to allow carriers to offer up to 3 alternative individual health plan designs and up to 3 alternative small group health plan designs. Like LD 519, this is a repeat of a bill introduced last session and has little hope of passing.
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