This bill mandates that insurers must count any payments made by independent charity patient assistance programs towards the patient's cost-sharing obligations for prescription drugs, except when a generic, biosimilar, or other covered alternative drug is available. The bill defines "cost-sharing" to include coinsurance, copayments, deductibles, or out-of-pocket maximums, and specifies the criteria for an "independent charity patient assistance program" based on standards set by the U.S. Department of Health and Human Services Office of Inspector General. Insurers are required to apply these payments to an enrollee's cost-sharing requirements if the assistance is offered for the full plan year. Additionally, the bill outlines the information that pharmacies must provide to insurers when processing payments from such programs.

The bill exempts high deductible and catastrophic health plans from these provisions until the enrollee's deductible is met for the year. It is set to take effect on January 1, 2026. The fiscal note attached to the bill indicates that there is no direct fiscal impact on state, county, or local revenues or expenditures. However, it suggests that insurers might increase future premiums to offset the financial assistance provided, which could indirectly increase state revenue from insurance premium taxes. The bill also aims to clarify the role of independent charity patient assistance programs in providing subsidies, which could have long-term inflationary effects on healthcare costs due to the high cost of specialty drugs. The Insurance Department has been contacted for this bill.

Statutes affected:
As Amended by the House: 415:18