S.B. No. 1287 amends Section 1369.0542 of the Insurance Code to clarify the application of reductions in out-of-pocket expenses for prescription drugs that are considered essential health benefits. The bill specifies that these reductions must be applied to the enrollee's deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum, regardless of how the health benefit plan issuer, pharmacy benefit manager, or subcontractor classifies the drug. The new language also defines "subcontractor" as any entity to whom the health benefit plan issuer or pharmacy benefit manager delegates functions or services, excluding their employees.

The bill will take effect on September 1, 2025, and will apply only to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026. Plans that are delivered or renewed before this date will continue to be governed by the existing law prior to the amendments made by this Act.

Statutes affected:
Introduced: Insurance Code 1369.0542 (Insurance Code 1369)