Healthcare (Insurance)

This bill directs Utah's state health plan (PEHP) to make specific changes to its drug coverage starting in 2027. It requires PEHP to include at least one non-opioid pain medication alternative for every opioid drug in its formulary (drug list), and prohibits using cost-sharing, prior authorization, or other extra steps to discourage patients from choosing these alternatives. The resolution aims to address coverage gaps that may lead patients toward opioids instead of safer options. (Note: This is a procedural resolution, not a law, and applies directly to PEHP's coverage policies.)

HB 71 requires health insurance companies (covered insurers) to help enrollees access behavioral health services (like mental health and substance use treatment) in a timely manner when in-network providers aren't available. Insurers must publish and regularly update accurate provider directories, facilitate out-of-network care within 7 days (or 24 hours for emergencies), and follow specific rules for single case agreements to cover out-of-network services. The bill also extends these requirements to Utah's Medicaid program and directs the state to create a working group to study a statewide behavioral health provider directory. These changes apply to all insurers offering behavioral health coverage, effective July 1, 2026.

SB 50 requires health insurance plans in Utah to cover medically necessary anesthesia services regardless of procedure duration, directly affecting patients needing anesthesia and insurers offering health coverage. It prohibits insurers from denying payment for anesthesia solely based on exceeding preset time limits, ensuring coverage isn't withheld for extended care. The law applies to health benefit plans renewed or entered after January 1, 2027, and is codified under Utah Code Section 31A-22-663. This bill takes effect on May 6, 2026, with no new state funding required.