Calculation Of Contributions To Meet Cost Sharing

For health benefit plans issued or renewed on or after January 1, 2025, the act requires a health insurer or pharmacy benefit manager to include in the calculation of a covered person's contributions toward cost-sharing requirements, including any annual limitation on a covered person's out-of-pocket costs, any payments made by or on behalf of the covered person for a prescription drug if:

• The prescription drug does not have a generic equivalent or, for a biological product, a biosimilar drug or interchangeable biological product; or
• The prescription drug has a generic equivalent, a biosimilar drug, or an interchangeable biological product, but the covered person is using the brand-name drug after obtaining prior authorization, complying with a step-therapy protocol, or otherwise receiving approval from the carrier or pharmacy benefit manager if those utilization management processes are not otherwise prohibited by law.

The commissioner of insurance is authorized to adopt rules necessary to implement the act. The act applies to health benefit plans issued or renewed on or after January 1, 2025.

APPROVED by Governor June 5, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)