An Act To Provide Consumers of Health Care with Information Regarding Health Care Costs
Maine Legislature, Session 127, LD 0636
Committee: Insurance and Financial Services
Sponsors: DILL, SANBORN, ALFOND, GRATWICK, SAVIELLO, FARNSWORTH, NOON
Amends: 24-A MRSA §4303

Legislative Document 
No. 636 
S.P. 229 
In Senate, March 3, 2015 
An Act To Provide Consumers of Health Care with Information 
Regarding Health Care Costs 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
HEATHER J.R. PRIEST 
Secretary of the Senate 
Presented by Senator DILL of Penobscot. 
Cosponsored by Representative SANBORN of Gorham and 
Senators: ALFOND of Cumberland, GRATWICK of Penobscot, SAVIELLO of Franklin, 
Representatives: FARNSWORTH of Portland, NOON of Sanford. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §4303, sub-§20 is enacted to read: 
20.  Information about prescription drugs.  A carrier offering a health plan in this 
State shall provide the following information to prospective enrollees and enrollees with 
respect to prescription drug coverage on its publicly accessible website. 
A.  A carrier shall post each prescription drug formulary for each health plan offered 
by the carrier. The prescription drug formularies must be posted in a manner that 
allows prospective enrollees and enrollees to search the formularies and compare 
formularies to determine whether a particular prescription drug is covered under a 
formulary.  When a change is made to a formulary, the updated formulary must be 
posted on the website within 72 hours. 
B.  A carrier shall provide an explanation of: 
(1)  The requirements for utilization review, prior authorization or step therapy 
for each category of prescription drug covered under a health plan; 
(2)  The cost-sharing requirements for prescription drug coverage, including a 
description of how the costs of prescription drugs will specifically be applied or 
not applied to any deductible or out-of-pocket maximum required under a health 
plan; 
(3)  The exclusions from coverage under a health plan and any restrictions on use 
or quantity of covered health care services in each category of benefits; and 
(4)  The amount of coverage provided under a health plan for out-of-network 
providers or noncovered health care services and any right of appeal available to 
an enrollee when out-of-network providers or noncovered health care services are 
medically necessary. 
SUMMARY 
This bill requires all health insurance carriers offering individual and group health 
plans to provide certain information with respect to prescription drug coverage to 
prospective enrollees and enrollees on its publicly accessible website. The bill requires 
carriers to post each prescription drug formulary for each health plan in a manner that 
allows enrollees to determine whether a particular prescription drug is covered under a 
formulary. The bill also requires carriers to provide information about utilization review, 
prior authorization or step therapy, cost-sharing, exclusions from coverage and the 
amount of coverage for out-of-network providers or noncovered health care services.