The bill amends the General Laws by adding new definitions and clarifying terms related to prescription drug benefits. It introduces Section 27-20.8-1, which defines "cost sharing" to include copayments, coinsurance, deductibles, and annual limitations required for specific healthcare services, including prescription drugs. The bill also defines "insurer," "person," and "pharmacy benefit manager," expanding the understanding of entities involved in healthcare services and insurance.

Additionally, the bill establishes Section 27-20.8-5, which mandates that when calculating an enrollee's overall contribution to out-of-pocket maximums or cost-sharing requirements, insurers and pharmacy benefit managers must include amounts paid by the enrollee or on their behalf for prescriptions that are either without a generic equivalent or obtained through specific processes such as prior authorization, step therapy protocols, or the health care plan's exceptions and appeals process. This requirement will apply to health plans that are entered into, amended, extended, or renewed on or after January 1, 2026. The act will take effect upon passage.

Statutes affected:
6209: 27-20.8-1