SB579 Alabama 2012 Session

Summary

Primary Sponsor

Greg J. Reed

Republican

Session

Regular Session 2012

Title

Health benefit plans, prescription drugs, specify prescription drugs and methodology to determine coverage of a drug, Sec. 10A-20-6.16, 27-21A-23 am'd

Summary

SB579 would require health plans that use drug formularies to clearly explain coverage rules and to maintain contracted drug benefits for previously approved drugs through plan renewal, even if the drug is later removed from the formulary.

What This Bill Does

It requires plans with prescription drug coverage that use formularies to provide plain-language information about how coverage works, what a formulary is, how drugs are chosen, how often the formulary is reviewed, and how to check if a drug is included. It also requires disclosure to a covered individual within three business days if a specific drug is on the formulary. Additionally, the plan must offer to cover any drug that was approved or covered at the contracted level through the plan renewal date, even if that drug is removed from the formulary, and allows physicians to prescribe a medically appropriate alternative that is covered. An adverse determination would occur if a drug is not on the formulary and the physician has determined it is medically necessary.

Who It Affects

• Enrollees/covered individuals in Alabama, who would receive formulary information and may retain coverage for previously approved drugs through renewal even after formulary changes
• Health benefit plans/insurers (including HMOs, PPOs, and similar entities), which must provide disclosures, manage formulary information, handle requests for drug inclusion, and determine coverage rules
• Self-funded plans administered by a corporation, which are exempt from some of the required coverage offerings

Key Provisions

• Plans must provide plain-language disclosures about drug formularies, including what a formulary is, how drugs are chosen or excluded, how often the formulary is reviewed, and how to check if a drug is included
• Plans must disclose within three business days, upon request, whether a specific drug is included in a formulary
• Plans must notify enrollees that inclusion in a formulary does not guarantee that a provider will prescribe a drug for a given condition
• Plans must offer to cover any drug that was approved or covered under the plan for a condition at the contracted benefit level through the renewal date, even if the drug is removed from the formulary
• Physicians may prescribe an alternative drug that is covered and medically appropriate

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health Insurance