02/21/2024

February Legislative Update

This month, your OSMA Advocacy team has been working extensively behind the scenes with legislators and other interested parties on several key issues, preparing for upcoming legislative sessions next week and later this spring after the primary election.

House Bill 130 – Prior Authorization Gold Card

Often, in order for proposed legislation to move forward in the legislative process, after the initial version is introduced, amendments are added to the bill and/or a substitute version or versions is created after the further collaboration and deliberation of interested parties. OSMA has been working with the sponsor of HB 130, Rep. Kevin Miller (R-Newark), and other interested parties on a substitute bill, and it was accepted earlier this month. This is great progress on our high priority prior authorization reform issue after many months of meetings, including with the health plans.

We will be providing further detail in upcoming updates, but we are confident that the changes made in the substitute version of the bill will retain meaningful change to reduce the burden of prior authorization for our members, while lessening the opposition to the bill from the insurance industry and making its path through the legislature smoother.   

House Bill 291 – Non-Medical Switching

Similarly, in response to strong opposition from the health plans, an amendment to HB 291, which would prohibit health plans from engaging in the practice of non-medical switching, was accepted. As a reminder, non-medical switching occurs when health plan issuers or pharmacy benefit managers (PBMs) force patients to switch from a medication they rely on to treat their condition to a different medication (that is potentially less effective), for a non-medical reason.

The original bill bans non-medical switching outright, but the amendment allows for potential changes by the insurer if the cost of a medication increases by 5% or higher in calendar year.  OSMA believes this compromise will help this legislation advance, without losing the overall positive impact of the bill. With this amendment, HB 291 would still prevent non-medical switching in the majority of circumstances faced by patients.

Please stay tuned for future updates on these and other key issues OSMA is working on this year, and make a plan to vote in the March 19 primary election—early in-person and absentee ballot voting started this week.