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HOUSE DOCKET, NO. 2157 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 988
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Marjorie C. Decker
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to patient financial protection.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/11/2023 1 of 3
HOUSE DOCKET, NO. 2157 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 988
By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 988) of
Marjorie C. Decker relative to regulating separate out-of-pocket insurance limits for prescription
drugs, including specialty drugs. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1059 OF 2021-2022.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act relative to patient financial protection.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition,
2is hereby amended by inserting after section 47PP the following section:-
3 Section 47QQ. Any policy, contract, agreement, plan or certificate of insurance issued,
4delivered or renewed within the commonwealth that provides coverage for prescription drugs
5shall establish a separate out-of-pocket limit for prescription drugs, which shall include specialty
6drugs. The out-of-pocket limit shall not exceed the dollar amount set as the minimum annual
7deductible for a high deductible health plan under section 223 of the federal Internal Revenue
8Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for self-only and family coverage, respectively. For
9the purposes of this section the term “out-of-pocket limit” shall include expenses that: (1) are a 2 of 3
10cost-sharing expenditure under section 1302 of the federal Patient Protection and Affordable
11Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate to prescription drug coverage.
12 SECTION 2. Chapter 176A of the General Laws, as appearing in the 2020 Official
13Edition, is hereby amended by inserting after section 8QQ the following section:-
14 Section 8RR. Any contract between a subscriber and the corporation under an individual
15or group hospital service plan which is delivered, issued or renewed within the commonwealth
16that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for
17prescription drugs, which shall include specialty drugs. The out out-of-pocket limit shall not
18exceed the dollar amount set as the minimum annual deductible for a high deductible health plan
19under section 223 of the federal Internal Revenue Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for
20self-only and family coverage, respectively. For the purposes of this section the term “out-of-
21pocket limit” shall include expenses that: (1) are a cost-sharing expenditure under section 1302
22of the federal Patient Protection and Affordable Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate
23to prescription drug coverage.
24 SECTION 3. Chapter 176B of the General Laws, as appearing in the 2020 Official
25Edition, is hereby amended by inserting after section 4QQ the following section:-
26 Section 4RR. Any subscription certificate under an individual or group medical service
27agreement delivered, issued or renewed within the commonwealth that provides coverage for
28prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, which
29shall include specialty drugs. The out-of-pocket limit shall not exceed the dollar amount set as
30the minimum annual deductible for a high deductible health plan under section 223 of the federal
31Internal Revenue Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for self-only and family coverage, 3 of 3
32respectively. For the purposes of this section the term “out-of-pocket limit” shall include
33expenses that: (1) are a cost-sharing expenditure under section 1302 of the federal Patient
34Protection and Affordable Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate to prescription drug
35coverage.
36 SECTION 4. Chapter 176G of the General Laws, as appearing in the 2020 Official
37Edition, is hereby amended by inserting after section 4GG the following section:-
38 Section 4HH. Any individual or group health maintenance organization that provides
39coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription
40drugs, which shall include specialty drugs. The out-of-pocket limit shall not exceed the dollar
41amount set as the minimum annual deductible for a high deductible health plan under section
42223of the federal Internal Revenue Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for self-only and
43family coverage, respectively. For the purposes of this section the term “out-of-pocket limit”
44shall include expenses that: (1) are a cost-sharing expenditure under section 1302 of the federal
45Patient Protection and Affordable Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate to
46prescription drug coverage.
47 SECTION 5. This act shall apply to all policies, contracts and certificates of health
48insurance subject to section 47QQ of chapter 175, section 8RR of chapter 176A, section 4RR of
49chapter 176B and section 4HH of chapter 176G of the General Laws delivered, issued or
50renewed on or after January 1, 2023.