SB 1102, a bill to limit pharmacy benefit manager (PBM) and insurer changes to previously covered prescriptions, was presented to the caucus and placed on third-read consent.

Supporters said the bill would prevent insurers or PBMs from removing coverage for a drug a patient is already taking if that drug was previously approved for that individual and the individual remains enrolled in the plan. The bill would also require written or electronic notice to both the affected individual and the individual's prescribing health care provider at least 60 days before a formulary change that limits or excludes a previously covered drug. The bill also creates a formulary-exception process and allows covered individuals who do not qualify for the exception to still apply for a formulary exception through that process.

Why it matters: Proponents framed the bill as a consumer protection measure for people who have been stabilized on a medication and then lose coverage when a PBM or insurer revises a formulary. During caucus discussion, Representative Cruz offered a personal example of the bill's stakes: “My son was dropped from his insurance ... We tried different generics that were approved. They made my son very, very ill,” Representative Cruz said, describing how his family has paid cash for medication since the change. He added that while the bill would not help his son retroactively, he supported it so other Arizonans would not face similar harm.

Details in the bill as presented: it bars PBMs and insurers that enter into an agreement to provide pharmacy benefit management services from limiting or excluding coverage for a prescription drug for a covered individual if (1) the drug was previously approved by the PBM or insurer for that individual and (2) the individual remains enrolled. If a prescribing health care provider provides written or electronic notice that the individual shall continue on the current prescription, the PBM or insurer may not change the individual's coverage for that prescription. The bill requires 60 days' written or electronic notice of formulary removal or change to both the impacted covered individual and the prescribing provider.

Process and next steps: The presenter said the bill was on third-read consent and was available for questions; caucus members did not record a formal vote during the meeting transcript. No amendments or formal motions were recorded in the transcript. The bill’s formulary-exception language and 60-day notice requirement were flagged as key implementation items for affected insurers, PBMs and prescribing clinicians.

Ending: The caucus did not record a vote on SB 1102 during the session excerpted in the transcript; the bill remained listed on the consent calendar with the presenter available for questions.