District Of Columbia 2023-2024 Regular Session

District Of Columbia Council Bill B25-0141 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
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	1	+	ENGROSSED ORIGINAL
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8		-	AN ACT
9		-
10		-	_______________
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12		-
13		-	IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
14		-
15		-	_________________
16		-
17		-
18		-	To amend the Specialty Drug Copayment Limitation Act to require health insurers to apply
19		-	discounts, financial assistance payments, product vouchers, or other reductions in out-of-
20		-	pocket expenses made by or on behalf of a member when calculating the member’s
21		-	coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket
22		-	maximum for prescription drugs.
23		-
24		-	BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
25		-	act may be cited as the “Copay Accumulator Amendment Act of 2023.”
26		-
27		-	Sec. 2. The Specialty Drug Copayment Limitation Act of 2016, effective April 7, 2017
28		-	(D.C. Law 21-248; D.C. Official Code § 48-855.01 et seq.), is amended as follows:
29		-	(a) Section 2 (D.C. Official Code § 48-855.01) is amended as follows:
30		-	(1) A new paragraph (3C) is added to read as follows:
31		-	“(3C) “Generic drug” means a chemically equivalent copy of a brand-name drug
32		-	with an expired patent.”.
33		-	(2) A new paragraph (5A) is added to read as follows:
34		-	“(5A) “Interchangeable biological product” means a biological product that is
35		-	licensed and determined by the Food and Drug Administration to meet the standards for
36		-	interchangeability under 42 U.S.C. § 262(k)(4) or determined to be biosimilar to and
37		-	interchangeable with a reference biological product as stated in the Lists of Licensed Biological
38		-	Products with Reference Product Exclusivity and Biosimilarity or Interchangeability
39		-	Evaluations, also known as the Purple Books.”.
40		-	(b) A new section 3b is added to read as follows:
41		-	“Sec. 3b. Calculation of member’s contributions for a prescription drug covered under the
42		-	health benefit plan.
43		-	“(a) Except as otherwise provided in subsection (b) of this section, when calculating a
44		-	member’s contribution to their coinsurance, copayment, cost-sharing responsibility, deductible,
45		-	or out-of-pocket maximum under the member’s health benefit plan, the health insurer shall
46		-	include any discount, financial assistance payment, product voucher, or any other out-of-pocket ENROLLED ORIGINAL
	8	+	A BILL 1
	9	+	2
	10	+	25-141 3
	11	+	4
	12	+	5
	13	+	IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 6
	14	+	7
	15	+	_________________ 8
	16	+	9
	17	+	10
	18	+	To amend the Specialty Drug Copayment Limitation Act to require health insurers to apply 11
	19	+	discounts, financial assistance payments, product vouchers, or other reductions in out-of-12
	20	+	pocket expenses made by or on behalf of a member when calculating the member’s 13
	21	+	coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket 14
	22	+	maximum for prescription drugs. 15
	23	+	16
	24	+	BE IT ENACTED BY THE COUNCIL OF THE DIST RICT OF COLUMBIA, That this 17
	25	+	act may be cited as the “Copay Accumulator Amendment Act of 2023.” 18
	26	+	Sec. 2. The Specialty Drug Copayment Limitation Act of 2016, effective April 7, 2017 19
	27	+	(D.C. Law 21-248; D.C. Official Code § 48-855.01 et seq.), is amended as follows: 20
	28	+	(a) Section 2 (D.C. Official Code § 48-855.01) is amended as follows: 21
	29	+	(1) A new paragraph (3C) is added to read as follows: 22
	30	+	“(3C) “Generic drug” means a chemically equivalent copy of a brand-name drug 23
	31	+	with an expired patent.”. 24
	32	+	(2) A new paragraph (5A) is added to read as follows: 25
	33	+	“(5A) “Interchangeable biological product” means a biological product that is 26
	34	+	licensed and determined by the Food and Drug Administration to meet the standards for 27
	35	+	interchangeability under 42 U.S.C. § 262(k)(4) or determined to be biosimilar to and 28 ENGROSSED ORIGINAL
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48	37
49	38
50	39
51	40		2
52	41
53		-	expense made by or on behalf of the member for a prescription drug covered under the member’s
54		-	health benefit plan that:
55		-	“(1) Is without a generic drug equivalent or an interchangeable biological product
56		-	preferred under the health benefit plan’s formulary; or
57		-	“(2) Has a generic equivalent drug or an interchangeable biological product
58		-	preferred under the health benefit plan’s formulary where the member has obtained access to the
59		-	drug through prior authorization, a step therapy protocol, or the exception or appeal process of
60		-	the health insurer or pharmacy benefits manager.
61		-	“(b) Subsection (a) of this section shall not apply to a member covered by a high
62		-	deductible health plan, as that term is defined under 26 U.S.C. § 223, until the member satisfies
63		-	their minimum deductible; except, that subsection (a) of this section shall apply to contribution
64		-	amounts made for preventative care, as that term is defined under 26 U.S.C. § 223(c)(2)(C).
65		-	“(c) This section shall apply to health benefit plans entered into, amended, extended, or
66		-	renewed on or after January 1, 2025.”.
67		-
68		-	Sec. 3. Fiscal impact statement.
69		-	The Council adopts the fiscal impact statement in the committee report as the fiscal
70		-	impact statement required by section 4a of the General Legislative Procedures Act of 1975,
71		-	approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a).
72		-
73		-	Sec. 4. Effective date.
74		-	This act shall take effect following approval by the Mayor (or in the event of veto by the
75		-	Mayor, action by the Council to override the veto), a 30-day period of congressional review as
76		-	provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December
77		-	24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of
78		-	Columbia Register.
79		-
80		-
81		-	______________________________
82		-	Chairman
83		-	Council of the District of Columbia
	42	+	interchangeable with a reference biological product as stated in the Lists of Licensed Biological 29
	43	+	Products with Reference Product Exclusivity and Biosimilarity or Interchangeability 30
	44	+	Evaluations, also known as the Purple Books.”. 31
	45	+	(b) A new section 3b is added to read as follows: 32
	46	+	“Sec. 3b. Calculation of member’s contributions for a prescription drug covered under the 33
	47	+	health benefit plan. 34
	48	+	“(a) Except as otherwise provided in subsection (b) of this section, when calculating a 35
	49	+	member’s contribution to their coinsurance, copayment, cost-sharing responsibility, deductible, 36
	50	+	or out-of-pocket maximum under the member’s health benefit plan, the health insurer shall 37
	51	+	include any discount, financial assistance payment, product voucher, or any other out-of-pocket 38
	52	+	expense made by or on behalf of the member for a prescription drug covered under the member’s 39
	53	+	health benefit plan that: 40
	54	+	“(1) Is without a generic drug equivalent or an interchangeable biological product 41
	55	+	preferred under the health benefit plan’s formulary; or 42
	56	+	“(2) Has a generic equivalent drug or an interchangeable biological product 43
	57	+	preferred under the health benefit plan’s formulary where the member has obtained access to the 44
	58	+	drug through prior authorization, a step therapy protocol, or the exception or appeal process of 45
	59	+	the health insurer or pharmacy benefits manager. 46
	60	+	“(b) Subsection (a) of this section shall not apply to a member covered by a high 47
	61	+	deductible health plan, as that term is defined under 26 U.S.C. § 223, until the member satisfies 48 ENGROSSED ORIGINAL
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88		-	_________________________________
89		-	Mayor
90		-	District of Columbia
	66	+	3
91	67
	68	+	their minimum deductible; provided, subsection (a) of this section shall apply to contribution 49
	69	+	amounts made for preventative care, as that term is defined under 26 U.S.C. § 223(c)(2)(C). 50
	70	+	“(c) This section shall apply to health benefit plans entered into, amended, extended, or 51
	71	+	renewed on or after January 1, 2025.”. 52
	72	+	Sec. 3. Fiscal impact statement. 53
	73	+	The Council adopts the fiscal impact statement in the committee report as the fiscal 54
	74	+	impact statement required by section 4a of the General Legislative Procedures Act of 1975, 55
	75	+	approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 56
	76	+	Sec. 4. Effective date. 57
	77	+	This act shall take effect following approval by the Mayor (or in the event of veto by the 58
	78	+	Mayor, action by the Council to override the veto), a 30-day period of congressional review as 59
	79	+	provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 60
	80	+	24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of 61
	81	+	Columbia Register. 62