The bill amends sections of the General Laws in Chapter 27-20.8, titled "Prescription Drug Benefits," to clarify definitions and enhance the calculation of cost-sharing for enrollees. New definitions are introduced, including "cost sharing," which encompasses copayments, coinsurance, deductibles, and annual limitations required for healthcare services, including prescription drugs. Additionally, the bill defines terms such as "insurer," "person," and "pharmacy benefit manager," which are essential for understanding the roles of various entities involved in health plans.

Furthermore, the bill stipulates that when calculating an enrollee's overall contribution to out-of-pocket maximums or cost-sharing requirements, insurers or pharmacy benefit managers must include any amounts paid by the enrollee or on their behalf by another person. This requirement applies specifically to cases where there is no generic equivalent for a drug or when access to a drug is obtained through prior authorization, step therapy protocols, or exceptions and appeals processes. The new provisions will take effect for health plans that are entered into, amended, extended, or renewed on or after January 1, 2027.