The bill amends Chapter 27-20.8 entitled "Prescription Drug Benefits" of the General Laws with new definitions and provisions regarding cost sharing in health plans. It introduces the term "cost sharing" to mean any financial contribution required from an enrollee, such as copayments, coinsurance, deductibles, or any annual limitations on these contributions, to receive a specific health care service, including prescription drugs. The bill also expands definitions to include terms such as "insurer," "person," and "pharmacy benefit manager," providing a broader scope of entities and individuals involved in health care services and prescription drug programs.

Furthermore, the bill adds a new section, 27-20.8-5, which mandates that when calculating an enrollee's contribution to any out-of-pocket maximum or cost-sharing requirement under a health plan, the insurer or pharmacy benefit manager must include any amounts paid by the enrollee or on behalf of the enrollee by another person. This provision is set to apply to health plans that are entered into, amended, extended, or renewed on or after January 1, 2025. The act will take effect upon passage, ensuring that all payments contributing to an enrollee's cost-sharing obligations are accounted for, potentially reducing the financial burden on individuals seeking health care services and medications.

Statutes affected:
8041: 27-20.8-1