SB0435

Prohibition on copay accumulator adjustments.

Latest bill text (Comm Sub) [PDF]

Summary

Prohibition on copay accumulator adjustments. Provides that under certain circumstances, the administrator of the state employee health plan shall include any amount paid by a covered individual or another person on behalf of the covered individual for a prescription drug when calculating a covered individual's overall contribution to an out-of-pocket maximum or cost sharing requirement under the covered individual's state employee health plan. Provides that under certain circumstances, a pharmacy benefit manager shall include any amount paid by a covered individual or another person on behalf of the covered individual for a prescription drug when calculating a covered individual's overall contribution to an out-of-pocket maximum or cost sharing requirement under the covered individual's health plan. Provides that under certain circumstances, an insurer who issues a policy of accident and sickness insurance shall include any amount paid by an insured or another person on behalf of the insured for a prescription drug when calculating an insured's overall contribution to an out-of-pocket maximum or cost sharing requirement under the insured's policy of accident and sickness insurance. Provides that under certain circumstances, a health maintenance organization shall include any amount paid by an enrollee or another person on behalf of the enrollee for a prescription drug when calculating an enrollee's overall contribution to an out-of-pocket maximum or cost sharing requirement under the enrollee's individual or group contract.

Authors

Authored by Senator Hunley

Fiscal Outlook

Title Description Date View
Fiscal NoteFiscal Note #1: Introduced2025-01-13 Click To View

History

Date Chamber Action
2025-01-14SenateSenators Ford J.D. and Yoder added as coauthors
2025-01-13SenateFirst reading: referred to Committee on Health and Provider Services
2025-01-13SenateAuthored by Senator Hunley