The bill amends Chapter 27-20.8 entitled "Prescription Drug Benefits" of the General Laws to redefine and expand upon certain terms related to prescription drug benefits. New definitions are added for "cost sharing," "insurer," "person," and "pharmacy benefit manager," among others, to clarify the language and scope of the law. The term "cost sharing" is now defined to include copayments, coinsurance, deductibles, or any annual limitations on cost sharing required by or on behalf of an enrollee to receive a specific health care service, including prescription drugs. The bill also introduces new categories of entities under the definitions of "insurer" and "person," and provides a detailed definition of "pharmacy benefit manager."

Additionally, the bill introduces a new section, 27-20.8-5, titled "Cost sharing calculation," 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.

Statutes affected:
2720: 27-20.8-1