This bill amends various chapters of the General Laws to establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, in health insurance policies, contracts, and agreements issued or renewed within the Commonwealth. Specifically, it introduces new sections—47AAA in Chapter 175, 8EEE in Chapter 176A, 4EEE in Chapter 176B, and 4WW in Chapter 176G—that mandate this separate out-of-pocket limit. The limit cannot exceed the minimum annual deductible for high deductible health plans as defined in the federal Internal Revenue Code, and it includes expenses that are cost-sharing expenditures under the federal Patient Protection and Affordable Care Act.

The provisions outlined in the bill will take effect for all relevant policies, contracts, and certificates delivered, issued, or renewed on or after January 1, 2026. This legislative change aims to enhance patient financial protection by ensuring that individuals have a clear and manageable out-of-pocket limit for their prescription drug costs.