This bill amends Chapter 27-18 and Chapter 27-19 of the General Laws to address specialty drugs. It requires individual or group health insurance contracts, plans, or policies to limit the cost-sharing obligation for specialty drugs to $150 per month for each drug up to a 30-day supply. This limit applies after any deductible is reached and until the individual's maximum out-of-pocket limit has been reached. The bill also allows the health insurance commissioner to create rules and regulations to implement and administer this section. The bill defines terms such as "complex or chronic medical condition," "pre-service authorization," "rare medical condition," "specialty drug," and "specialty drug tier."

This bill inserts new legal language into current law to limit the cost-sharing obligation for specialty drugs in individual or group health insurance contracts, plans, or policies. The limit is set at $150 per month for each drug up to a 30-day supply, inclusive of any copayment or coinsurance. This limit applies after any deductible is reached and until the individual's maximum out-of-pocket limit has been reached. The bill also allows entities subject to this section to reduce a covered individual's cost sharing for a specialty drug to an amount less than the limit. The bill also adds a new section to the General Laws entitled "Nonprofit Medical Service Corporations" and "Health Maintenance Organizations" to address specialty drugs. The health insurance commissioner is authorized to promulgate rules and regulations to implement and administer this section.