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Councilmember Janeese Lewis George Councilmember Christina Henderson 2
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Councilmember Vincent C. Gray Councilmember Brianne K. Nadeau 6
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A BILL 15
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 20
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To amend the Specialty Drug Copayment Limitation Act to require health insurers to apply 25
discounts, financial assistance, payments, product vouchers, or other reductions in 26
out-of-pocket expenses made by or on behalf of a member when calculating the 27
member’s coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-28
pocket maximum for a covered benefit. 29
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BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this 31
act may be cited as the “Copay Accumulator Amendment Act of 2023.” 32
Sec. 2. The Specialty Drug Copayment Limitation Act of 2016, effective April 7, 2017 33
(D.C. Law 21-248; D.C. Official Code § 48-855.01 et seq.), is amended by adding a new section 34
3b to read as follows: 35
“3b. Calculation of enrollee’s contributions for a covered benefit. 36
“(a) To the extent permitted by federal law and regulation, a health insurer shall, when 37
calculating a member’s contribution to a coinsurance, copayment, cost-sharing responsibility, 38 deductible, or out-of-pocket maximum for any covered benefit, apply any discount, financial 39
assistance, payment, product voucher, or any other reduction in out-of-pocket expenses made by 40
or on behalf of the member. 41
“(b) This section shall apply with respect to health plans that are entered into, amended, 42
extended, or renewed on or after January 1, 2025.”. 43
Sec. 3. Fiscal impact statement. 44
The Council adopts the fiscal impact statement in the committee report as the fiscal 45
impact statement required by section 4a of the General Legislative Procedures Act of 1975, 46
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 47
Sec. 4. Effective date. 48
This act shall take effect following approval by the Mayor (or in the event of veto by the 49
Mayor, action by the Council to override the veto), a 30-day period of congressional review as 50
provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 51
24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of 52
Columbia Register. 53