Resolution seeks review of protections lost in annulled health law
New Progressive Party Sen. Nitza Morán has introduced Senate Resolution 0341 directing the chamber’s Health, Economic Development, Small Business, Banking, Commerce, Insurance and Cooperativism committees to conduct an “exhaustive investigation” into the execution, compliance and current status of Act 142-2020.
The review would examine the law’s intent, its protections for medical judgment and its requirement for immediate access to prescription medications.
It also calls for an assessment of the effects of the law’s judicial annulment and the development of possible corrective or substitute legislation.
The measure’s explanatory statement stresses that access to health care is a fundamental right. “In Puerto Rico, adequate and necessary access to medical treatment should not be conditioned by bureaucratic administrative practices that violate the clinical judgment of the health professional nor by bureaucratic processes that expose the patient to interruptions in their treatment, which put them at risk,” the bill states.
“Act 142-2020 was enacted with the clear objective of correcting an unfair and harmful practice such as the alteration of medical criteria by insurers; and in turn, to cover the lack of provision of the drug during the time in which medical exceptions or appeals are evaluated on the coverage determinations to which each premium responds,” it continues.
The 2020 law established immediate temporary coverage for prescription drugs and prohibited insurers from overriding a prescribing physician’s medical judgment. It also required clear guidance for patients whose medications were denied.
Implementation, however, was halted after legal disputes under the Puerto Rico Oversight, Management and Economic Stability Act (Promesa). The court found that Act 142-2020, along with other measures, conflicted with the fiscal plan approved by the Financial Oversight and Management Board.
“Despite this annulment, it is not clear whether the government of Puerto Rico, its regulatory agencies, insurers, Pharmacy Benefit Administrators and other entities have completely ceased the implementation of the measures contained in said law, if they have established alternative protocols or if they have adopted other practices that seek the same or a similar effect in favor of the patient,” the statement adds.
“It is necessary to be certain about the repercussions of this matter and the viability of new efforts to restore, reformulate or replace the provisions of Act 142-2020,” it says.
Real-world impact on patients
The resolution argues that lawmakers must determine the law’s real-world status after the annulment, including its effect on prescription access and the preservation of clinical judgment.
“This legislative investigation will not only seek to clarify the validity and historical compliance of Act 142-2020 and the practical consequences of its annulment, but will also seek to identify viable alternatives that restore the essential protections that the law sought, particularly with regard to physician clinical judgment, continued access to prescription drugs and clear patient guidance,” the measure states.
The process will also examine the scope and basis of the annulment under Promesa and consider possible legislative, regulatory or administrative tools that could withstand fiscal and constitutional review.
The bill asserts that the Senate “has the duty to oversee, legislate and guarantee that decisions outside the local democratic framework do not result in the lack of protection of the most vulnerable sectors.”
“Only in this way will it be possible to strengthen trust in the health system, avoid damage to public health and promote greater equity and dignity, resulting in access to essential medical services,” it adds.
Under the resolution, the assigned committees may hold public hearings, summon officials and witnesses, request documents and conduct site inspections. The measure has been referred to the Senate Internal Affairs Committee.
