Maryland 2025 Regular Session

Maryland Senate Bill SB773 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3	3		EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4		[Brackets] indicate matter deleted from existing law.
5	5		Underlining indicates amendments to bill.
6	6		Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7	7		amendment.
8		-	Italics indicate opposite chamber/conference committee amendments.
9	8		sb0773
10	9
11	10		SENATE BILL 773
12		-	J5 (5lr1848)
13		-	ENROLLED BILL
14		-	— Finance/Health and Government Operations —
15		-	Introduced by Senator Hershey
	11	+	J5 5lr1848
16	12
17		-	Read and Examined by Proofreaders:
18		-
19		-	_______________________________________________
20		-	Proofreader.
21		-	_______________________________________________
22		-	Proofreader.
23		-
24		-	Sealed with the Great Seal and presented to the Governor, for his approval this
25		-
26		-	_______ day of _______________ at _________________ _______ o’clock, ________M.
27		-
28		-	______________________________________________
29		-	President.
	13	+	By: Senator Hershey
	14	+	Introduced and read first time: January 27, 2025
	15	+	Assigned to: Finance
	16	+	Committee Report: Favorable with amendments
	17	+	Senate action: Adopted
	18	+	Read second time: February 21, 2025
30	19
31	20		CHAPTER ______
32	21
33	22		AN ACT concerning 1
34	23
35		-	Health Benefit Plans – Calculation of Cost Sharing ~~Cost–Sharing~~ Contribution – 2
	24	+	Health Benefit Plans – Calculation of Cost Sharing Contribution – 2
36	25		Requirements 3
37	26
38		-	FOR the purpose of requiring certain insurers, nonprofit health service plans, and health 4
39		-	maintenance organizations to include certain discounts, financial assistance 5
40		-	payments, product vouchers, and other out–of–pocket expenses made by or on behalf 6
41		-	of an insured or enrollee when calculating certain cost–sharing contributions for 7
42		-	certain prescription drugs; requiring certain persons that provide certain discounts, 8
43		-	financial assistance payments, product vouchers, or other out–of–pocket expenses to 9
44		-	notify an insured or enrollee of certain information and to provide a certain statement 10
45		-	to the insured or enrollee; prohibiting certain insurers, nonprofit health service plans, 11
46		-	and health maintenance organizations from setting, altering, implementing, or 12
47		-	conditioning the terms of certain coverage based on the availability or amount of 13
48		-	financial or product assistance available for a prescription drug; providing that a 14
49		-	violation of a certain provision of this Act is considered a violation of the Consumer 15 2 SENATE BILL 773
	27	+	FOR the purpose of requiring administrators, carriers, and pharmacy benefits managers to 4
	28	+	include certain cost sharing amounts paid by or on behalf of an enrollee or a 5
	29	+	beneficiary when calculating the enrollee’s or beneficiary’s contribution to a cost 6
	30	+	sharing requirement for certain health care services; requiring administrators, 7
	31	+	carriers, and pharmacy benefits managers to include certain cost sharing amounts 8
	32	+	for providing that the calculation requirement does not apply to enrollees in certain 9
	33	+	high–deductible health plans after an enrollee or a beneficiary satisfies a certain 10
	34	+	requirement; prohibiting administrators, carriers, and pharmacy benefits managers 11
	35	+	from directly or indirectly setting, altering, implementing, or conditioning the terms 12
	36	+	of certain coverage based on certain information; requiring third parties that pay 13
	37	+	certain financial assistance to provide certain notification to an enrollee and 14
	38	+	prohibiting the third parties from conditioning the assistance on the enrollee taking 15
	39	+	certain actions; and generally relating to the calculation of cost sharing 16
	40	+	requirements. 17
	41	+
	42	+	BY adding to 18
	43	+	Article – Insurance 19
	44	+	Section 15–118.1 and 15–1611.3 20
	45	+	Annotated Code of Maryland 21
	46	+	(2017 Replacement Volume and 2024 Supplement) 22
	47	+
	48	+	Preamble 23 2 SENATE BILL 773
50	49
51	50
52		-	Protection Act; administrators, carriers, and pharmacy benefits managers to include 1
53		-	certain cost sharing amounts paid by or on behalf of an enrollee or a beneficiary when 2
54		-	calculating the enrollee’s or beneficiary’s contribution to a cost sharing requirement 3
55		-	for certain health care services; requiring administrators, carriers, and pharmacy 4
56		-	benefits managers to include certain cost sharing amounts for providing that the 5
57		-	calculation requirement does not apply to enrollees in certain high–deductible health 6
58		-	plans after an enrollee or a beneficiary satisfies a certain requirement; prohibiting 7
59		-	administrators, carriers, and pharmacy benefits managers from directly or indirectly 8
60		-	setting, altering, implementing, or conditioning the terms of certain coverage based 9
61		-	on certain information; requiring third parties that pay certain financial assistance 10
62		-	to provide certain notification to an enrollee and prohibiting the third parties from 11
63		-	conditioning the assistance on the enrollee taking certain actions; and generally 12
64		-	relating to the calculation of cost sharing requirements. 13
65	51
66		-	BY adding to 14
67		-	Article – Insurance 15
68		-	Section 15–118.1 and 15–1611.3 16
69		-	Annotated Code of Maryland 17
70		-	(2017 Replacement Volume and 2024 Supplement) 18
	52	+	WHEREAS, Cost sharing assistance is indispensable in helping many patients with 1
	53	+	rare, serious, and chronic diseases afford out–of–pocket costs for their essential and often 2
	54	+	life–saving medications; and 3
71	55
72		-	Preamble 19
	56	+	WHEREAS, Patients need cost sharing assistance because of the high out–of–pocket 4
	57	+	costs for their prescription medications; and 5
73	58
74		-	WHEREAS, Cost sharing assistance is indispensable in helping many patients with 20
75		-	rare, serious, and chronic diseases afford out–of–pocket costs for their essential and often 21
76		-	life–saving medications; and 22
	59	+	WHEREAS, When patients face unexpected charges during their health benefit plan 6
	60	+	year, they are less likely to adhere to their medication regimen; and 7
77	61
78		-	WHEREAS, Patients need cost sharing assistance because of the high out–of–pocket 23
79		-	costs for their prescription medications; and 24
	62	+	WHEREAS, Lack of patient adherence to needed medications leads to potential 8
	63	+	negative health consequences such as unnecessary emergency room visits, doctors’ visits, 9
	64	+	surgeries, and other interventions; and 10
80	65
81		-	WHEREAS, When patients face unexpected charges during their health benefit plan 25
82		-	year, they are less likely to adhere to their medication regimen; and 26
	66	+	WHEREAS, Patients are able to use cost sharing assistance only after they have met 11
	67	+	requirements for coverage for their medication, including the medication’s inclusion on the 12
	68	+	patient’s formulary and utilization management protocols, such as prior authorization and 13
	69	+	step therapy; and 14
83	70
84		-	WHEREAS, ~~Lack of patient adherence to needed medications leads to potential 27~~
85		-	~~negative health consequences~~ such as ~~unnecessary emergency room visits~~, ~~doctors’ visits,~~ 28
86		-	~~surgeries, and other interventions~~; and 29
	71	+	WHEREAS, Health insurers and pharmacy benefits managers have implemented 15
	72	+	programs, such as accumulator adjustment programs, to restrict cost sharing assistance 16
	73	+	from counting toward a patient’s deductible or annual out–of–pocket limit; and 17
87	74
88		-	WHEREAS, Patients are able to use cost sharing assistance only after they have met 30
89		-	requirements for coverage for their medication, including the medication’s inclusion on the 31
90		-	patient’s formulary and utilization management protocols, such as prior authorization and 32
91		-	step therapy; and 33
	75	+	WHEREAS, Because of accumulator adjustment programs, patients are required to 18
	76	+	continue to make payments even after they have reached their annual out–of–pocket limit, 19
	77	+	forcing them to pay their full deductible and annual out–of–pocket limit twice and denying 20
	78	+	them the benefit from these programs while increasing the financial burden they bear to 21
	79	+	access their life–saving medication; and 22
92	80
93		-	WHEREAS, Health insurers and pharmacy benefits managers have implemented 34
94		-	programs, such as accumulator adjustment programs, to restrict cost sharing assistance 35
95		-	from counting toward a patient’s deductible or annual out–of–pocket limit; and 36
	81	+	WHEREAS, Patients often are not aware of the inclusion of accumulator adjustment 23
	82	+	programs in their health plan contracts and tend to learn about these types of programs 24
	83	+	when they attempt to obtain their medication after their cost sharing assistance has run 25
	84	+	out, whether at the pharmacy, at the infusion center, or at home through the mail; and 26
96	85
97		-	WHEREAS, Because of accumulator adjustment programs, patients are required to 37
98		-	continue to make payments even after they have reached their annual out–of–pocket limit, 38 SENATE BILL 773 3
	86	+	WHEREAS, Accumulator adjustment programs allow health insurers and pharmacy 27
	87	+	benefits managers to “double dip” by accepting funds from both the cost sharing assistance 28
	88	+	program and the patient, beyond the original deductible amount and the annual 29
	89	+	out–of–pocket limit; and 30
	90	+
	91	+	WHEREAS, It is a matter of public interest to require health insurers and pharmacy 31
	92	+	benefits managers to count any amount paid by the patient or on behalf of the patient by 32
	93	+	another person toward the patient’s annual out–of–pocket limit and any cost sharing 33
	94	+	requirement, such as deductibles; now, therefore, 34
	95	+
	96	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND , 35
	97	+	That the Laws of Maryland read as follows: 36 SENATE BILL 773 3
99	98
100	99
101		-	forcing them to pay their full deductible and annual out–of–pocket limit twice and denying 1
102		-	them the benefit from these programs while increasing the financial burden they bear to 2
103		-	access their life–saving medication; and 3
104	100
105		-	WHEREAS, Patients often are not aware of the inclusion of accumulator adjustment 4
106		-	programs in their health plan contracts and tend to learn about these types of programs 5
107		-	when they attempt to obtain their medication after their cost sharing assistance has run 6
108		-	out, whether at the pharmacy, at the infusion center, or at home through the mail; and 7
	101	+	Article – Insurance 1
109	102
110		-	WHEREAS, Accumulator adjustment programs allow health insurers and pharmacy 8
111		-	benefits managers to “double dip” by accepting funds from both the cost sharing assistance 9
112		-	program and the patient, beyond the original deductible amount and the annual 10
113		-	out–of–pocket limit; and 11
	103	+	15–118.1. 2
114	104
115		-	WHEREAS, It is a matter of public interest to require health insurers and pharmacy 12
116		-	benefits managers to count any amount paid by the patient or on behalf of the patient by 13
117		-	another person toward the patient’s annual out–of–pocket limit and any cost sharing 14
118		-	requirement, such as deductibles; now, therefore, 15
	105	+	(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 3
	106	+	INDICATED. 4
119	107
120		-	~~SECTION 1.~~ ~~BE IT ENACTED BY~~ THE ~~GENERAL ASSEMBLY~~ OF ~~MARYLAND, 16~~
121		-	~~That the Laws of Maryland read as follows: 17~~
	108	+	(2) “ADMINISTRATOR ” HAS THE MEANING STAT ED IN § 8–301 OF THIS 5
	109	+	ARTICLE. 6
122	110
123		-	Article – Insurance 18
	111	+	(3) (I) “CARRIER” MEANS AN ENTITY SUBJECT TO TH E 7
	112	+	JURISDICTION OF THE COMMISSIONER THAT CON TRACTS OR OFFERS TO CONTRACT 8
	113	+	TO PROVIDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY OF THE COSTS 9
	114	+	OF HEALTH CARE SERVI CES UNDER A HEALTH B ENEFIT PLAN IN THE STATE: 10
124	115
125		-	~~15–118.1. 19~~
	116	+	(I) AN INSURER; 11
126	117
127		-	(A) ~~(1) THIS SECTION APPLIES TO:~~ 20
	118	+	(II) A NONPROFIT HEALTH S ERVICE PLAN; 12
128	119
129		-	(I) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 21
130		-	PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 22
131		-	ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 23
132		-	CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 24
	120	+	(III) A HEALTH MAINTENANCE ORGANIZATION ; AND 13
133	121
134		-	(II) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 25
135		-	HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 26
136		-	CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 27
	122	+	(IV) ANY OTHER PERSON THA T PROVIDES HEALTH BE NEFIT 14
	123	+	PLANS SUBJECT TO REG ULATION BY THE STATE. 15
137	124
138		-	(2) AN INSURER, A NONPROFIT HEALTH S ERVICE PLAN, OR A HEALTH 28
139		-	MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIP TION 29
140		-	DRUGS THROUGH A PHAR MACY BENEFITS MANAGE R IS SUBJECT TO THE 30
141		-	REQUIREMENTS OF THIS SECTION. 31
	125	+	(II) “CARRIER” INCLUDES: 16
142	126
143		-	(B) (1) SUBJECT TO PARAGRAPH (2) OF THIS S UBSECTION, WHEN 32
144		-	CALCULATING AN INSUR ED’S OR ENROLLEE’S CONTRIBUTION TO TH E INSURED’S OR 33
145		-	ENROLLEE’S COINSURANCE , COPAYMENT , DEDUCTIBLE, OR OUT–OF–POCKET 34 4 SENATE BILL 773
	127	+	1. A HEALTH INSURANCE C OMPANY; 17
	128	+
	129	+	2. A NONPROFIT HOSPITAL AND MEDICAL SERVICE 18
	130	+	CORPORATION ; AND 19
	131	+
	132	+	3. A MANAGED CARE ORGAN IZATION. 20
	133	+
	134	+	(4) “COST SHARING ” MEANS ANY COPAYMENT , COINSURANCE , 21
	135	+	DEDUCTIBLE, OR OTHER SIMILAR CHA RGE REQUIRED OF AN E NROLLEE FOR A 22
	136	+	HEALTH CARE SERVICE COVERED BY A HEALT H BENEFIT PLAN , INCLUDING A 23
	137	+	PRESCRIPTION DRUG , AND PAID BY OR ON BE HALF OF THE ENROLLEE . 24
	138	+
	139	+	(5) “ENROLLEE” MEANS AN INDIVIDUAL ENTITLED TO PAYMENT FOR 25
	140	+	HEALTH CARE SERVICES FROM AN ADMINISTRATO R OR A CARRIER. 26
	141	+
	142	+	(6) (I) “HEALTH BENEFIT PLAN ” MEANS A POLICY , A CONTRACT, A 27
	143	+	CERTIFICATION , OR AN AGREEMENT OFFE RED OR ISSUED BY AN ADMINISTRATOR 28 4 SENATE BILL 773
146	144
147	145
148		-	MAXIMUM UNDER THE IN SURED’S OR ENROLLEE ’S HEALTH BENEFIT PLA N, AN 1
149		-	ENTITY SUBJECT TO TH IS SECTION SHALL I NCLUDE ANY DISCOUNT , FINANCIAL 2
150		-	ASSISTANCE PAYMENT , PRODUCT VOUCHER , OR OTHER OUT –OF–POCKET EXPENSE 3
151		-	MADE BY OR ON BEHALF OF THE INSURED OR EN ROLLEE FOR A PRESCRI PTION DRUG: 4
	146	+	OR A CARRIER TO PROV IDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY 1
	147	+	OF THE COSTS OF HEAL TH CARE SERVICES . 2
152	148
153		-	(I) THAT IS COVERED UNDE R THE INSURED ’S OR ENROLLEE ’S 5
154		-	HEALTH BENEFIT PLAN ; AND 6
	149	+	(II) “HEALTH BENEFIT PLAN ” DOES NOT INCLUDE A 3
	150	+	SELF–INSURED EMPLOYEE PLAN SUB JECT TO THE FEDERAL EMPLOYEE 4
	151	+	RETIREMENT INCOME ACT OF 1974 (ERISA). 5
155	152
156		-	(II) ~~1. THAT DOES NOT HAVE~~ A ~~N AB–RATED GENERIC 7~~
157		-	~~EQUIVALENT DRUG OR A N INTERCHANGEABLE BI OLOGICAL PRODUCT PRE FERRED 8~~
158		-	~~UNDER THE HEALTH BEN EFIT PLAN’S FORMULARY ;~~ OR 9
	153	+	(7) “HEALTH CARE SERVICE ” MEANS AN ITEM OR A S ERVICE 6
	154	+	PROVIDED TO AN INDIV IDUAL FOR THE PURPOS E OF PREVENTING , ALLEVIATING, 7
	155	+	CURING, OR HEALING HUMAN ILL NESS, INJURY, OR PHYSICAL DISABILI TY. 8
159	156
160		-	2. A. THAT HAS AN AB–RATED GENERIC EQUIVA LENT 10
161		-	DRUG OR AN INTERCHAN GEABLE BIOLOGICAL PR ODUCT PREFERRED UNDER THE 11
162		-	HEALTH BENEFIT PLAN ’S FORMULARY ; AND 12
	157	+	(B) THE ANNUAL LIMITATION ON COST SHARING PROV IDED FOR UNDER 42 9
	158	+	U.S.C. § 18022(C)(1) SHALL APPLY TO ALL H EALTH CARE SERVICES COVERED 10
	159	+	UNDER A HEALTH BENEF IT PLAN OFFERED OR I SSUED BY AN ADMINIST RATOR OR A 11
	160	+	CARRIER IN THE STATE. 12
163	161
164		-	B. FOR WHICH THE INSURE D OR ENROLLEE ORIGIN ALLY 13
165		-	OBTAINED COVERAGE TH ROUGH PRIOR AUTHORIZ ATION, A STEP THERAPY 14
166		-	PROTOCOL, OR THE EXCEPTION OR APPEAL PROCESS OF TH E ENTITY SUBJECT TO 15
167		-	THIS SECTION. 16
	162	+	(C) (1) SUBJECT TO PARAGRAPHS (2) AND (3) PARAGRAPH (2) OF THIS 13
	163	+	SUBSECTION, WHEN CALCULATING AN ENROLLEE’S CONTRIBUTION TO AN 14
	164	+	APPLICABLE COST SHAR ING REQUIREMENT , AN ADMINISTRATOR OR A CARRIER 15
	165	+	SHALL INCLUDE COST SHARING AMOUNTS PAID BY THE ENROLLEE OR O N BEHALF 16
	166	+	OF THE ENROLLEE BY A NOTHER PERSON . 17
168	167
169		-	(2) IF AN INSURED OR ENRO LLEE IS COVERED UNDE R A 17
170		-	HIGH–DEDUCTIBLE HEALTH PL AN, AS DEFINED IN 26 U.S.C. § 223, THIS 18
171		-	SUBSECTION DOES NOT APPLY TO THE DEDUCTI BLE REQUIREMENT OF T HE 19
172		-	HIGH–DEDUCTIBLE HEALTH PL AN. 20
	168	+	(2) IF THE APPLICATION OF THE THE REQUIREMENT UNDER 18
	169	+	PARAGRAPH (1) OF THIS SUBSECTION WOULD RESULT IN HEAL TH SAVINGS 19
	170	+	ACCOUNT INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE 20
	171	+	REQUIREMENT SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED 21
	172	+	HIGH–DEDUCTIBLE HEALTH PLANS WITH RE SPECT TO THE DEDUCTI BLE OF THE 22
	173	+	PLAN AFTER THE ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF 23
	174	+	THE INTERNAL REVENUE CODE DOES NOT APPL Y WITH RESPECT TO TH E 24
	175	+	DEDUCTIBLE REQUIREME NT OF A HIGH –DEDUCTIBLE HEALTH PL AN IF AN 25
	176	+	ENROLLEE IS COVERED UNDER A HIGH –DEDUCTIBLE HEALTH PL AN UNDER 26 26
	177	+	U.S.C. § 223. 27
173	178
174		-	(C) (1) EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS SUBSECTION , A 21
175		-	PERSON THAT PROVIDES A DISCOUNT, FINANCIAL ASSISTANCE PAYMENT, PRODUCT 22
176		-	VOUCHER, OR OTHER OUT –OF–POCKET EXPENSE MADE BY OR ON BEHALF OF THE 23
177		-	INSURED OR ENROLLEE THAT IS USED IN THE CALCULATION OF THE I NSURED’S OR 24
178		-	ENROLLEE’S CONTRIBUTION TO THE IN SURED’S OR ENROLLEE ’S COINSURANCE , 25
179		-	COPAYMENT , DEDUCTIBLE, OR OUT–OF–POCKET MAXIMUM SHALL , WITHIN 7 DAYS 26
180		-	AFTER THE ACCEPTANCE OF THE DISCOUNT , FINANCIAL ASSISTANCE PAYMENT, 27
181		-	PRODUCT VOUCHER , OR OTHER OUT–OF–POCKET EXPENSE , NOTIFY THE INSU RED 28
182		-	OR ENROLLEE OF : 29
	179	+	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 28
	180	+	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 29
	181	+	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 30
	182	+	ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF THE INTERNAL 31
	183	+	REVENUE CODE. 32
183	184
184		-	(I) THE MAXIMUM DOLLAR A MOUNT OF THE DISCOUN T, 30
185		-	FINANCIAL ASSISTANCE PAYMENT, PRODUCT VOUCHER , OR OTHER OUT –OF–POCKET 31
186		-	EXPENSE; AND 32
187		-
188		-	(II) THE EXPIRATION DATE FOR THE DISCOUNT , FINANCIAL 33
189		-	ASSISTANCE PAYMENT , PRODUCT VOUCHER , OR OTHER OUT–OF–POCKET EXPENSE . 34
190		-	SENATE BILL 773 5
	185	+	(D) AN ADMINISTRATOR OR A CARRIER MAY NOT DIRE CTLY OR INDIRECTLY 33
	186	+	SET, ALTER, IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN 34
	187	+	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 35
	188	+	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 36
	189	+	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG OR BIOLO GICAL PRODUCT . 37 SENATE BILL 773 5
191	190
192	191
193		-	(2) A VIOLATION OF PARAGRA PH (1) OF THIS SUBSECTION I S A 1
194		-	VIOLATION OF THE CONSUMER PROTECTION ACT. 2
195	192
196		-	(3) ~~THIS SUBSECTION DOES NOT APPLY TO~~ A ~~CHARI TABLE 3~~
197		-	~~ORGANIZATION THAT PR OVIDES A DISCOUNT~~ , ~~FINANCIAL ASSISTANCE PAYMENT,~~ 4
198		-	~~PRODUCT VOUCHER, OR OTHER~~ OUT –OF–POCKET EXPENSE TO AN ~~INSURED OR 5~~
199		-	~~ENROLLEE. 6~~
	193	+	(E) A THIRD PARTY THAT PAY S FINANCIAL ASSISTAN CE IN ANY AMOUNT , OR 1
	194	+	PORTION OF THE AMOUN T, OF ANY APPLICABLE CO ST–SHARING OR OTHER 2
	195	+	OUT–OF–POCKET EXPENSE ON BE HALF OF AN ENROLLEE FOR A COVERED 3
	196	+	PRESCRIPTION DRUG : 4
200	197
201		-	(D) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , AN ENTITY 7
202		-	SUBJECT TO THIS SECT ION MAY NOT DIRECTLY OR INDIRECTLY SET , ALTER, 8
203		-	IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN COVERAGE, 9
204		-	INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON INFORMATION 10
205		-	ABOUT THE AVAILABILI TY OR AMOUNT OF FINA NCIAL OR PRODUCT ASS ISTANCE 11
206		-	AVAILABLE FOR A PRES CRIPTION DRUG . 12
	198	+	(1) SHALL NOTIFY THE ENR OLLEE WITHIN 7 DAYS OF THE 5
	199	+	ACCEPTANCE OF THE FI NANCIAL ASSISTANCE O F THE TOTAL AMOUNT O F 6
	200	+	ASSISTANCE AVAILABLE AND THE DURATION FOR WHICH IT IS AVAILABL E; AND 7
207	201
208		-	(2) ~~PARAGRAPH (1) OF THIS SUBSECTION M AY~~ NOT ~~BE CONSTRUED TO 13~~
209		-	~~PROHIBIT AN ENTITY S UBJECT TO THIS SECTI ON FROM USING REBATE S IN THE 14~~
210		-	~~DESIGN OF PRESCRIPTI ON DRUG COVERAGE OR BENEFITS~~. 15
	202	+	(2) MAY NOT CONDITION TH E ASSISTANCE ON ENRO LLMENT IN A 8
	203	+	SPECIFIC HEALTH PLAN OR TYPE OF HEALTH P LAN, EXCEPT AS AUTHORIZED UNDER 9
	204	+	FEDERAL LAW . 10
211	205
212		-	(A) (1) ~~IN THIS SECTION~~ THE ~~F OLLOWING WORDS HAVE THE MEANINGS 16~~
213		-	~~INDICATED~~. 17
	206	+	(E) (F) THE COMMISSIONER MAY ADOP T REGULATIONS TO CAR RY OUT 11
	207	+	THIS SECTION. 12
214	208
215		-	(2) “ADMINISTRATOR ” HAS THE MEANING STAT ED IN § 8–301 OF THIS 18
216		-	ARTICLE. 19
	209	+	15–1611.3. 13
217	210
218		-	(3) (I) “CARRIER” MEANS AN ENTITY SUBJ ECT TO THE 20
219		-	JURISDICTION OF THE COMMISSIONER THAT CON TRACTS OR OFFERS TO CONTRACT 21
220		-	TO PROVIDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY OF THE COSTS 22
221		-	OF HEALTH CARE SERVI CES UNDER A HEALTH B ENEFIT PLAN IN THE STATE: 23
	211	+	(A) THIS SECTION APPLIES ONLY TO A PHARMACY B ENEFITS MANAGER 14
	212	+	THAT PROVIDES PHARMA CY BENEFITS MANAGEME NT SERVICES ON BEHALF OF A 15
	213	+	CARRIER. 16
222	214
223		-	(I) AN INSURER; 24
	215	+	(B) (1) SUBJECT TO PARAGRAPHS (2) AND (3) PARAGRAPH (2) OF THIS 17
	216	+	SUBSECTION, WHEN CALCULATING A B ENEFICIARY’S CONTRIBUTION TO AN 18
	217	+	APPLICABLE COST SHAR ING REQUIREMENT , A PHARMACY BENEFITS MANAGER 19
	218	+	SHALL INCLUDE COST S HARING AMOUNTS PAID BY THE BENEFICIARY O R ON BEHALF 20
	219	+	OF THE BENEFICIARY B Y ANOTHER PERSON . 21
224	220
225		-	(II) A NONPROFIT HEALTH S ERVICE PLAN; 25
	221	+	(2) IF THE APPLICATION OF THE THE REQUIREMENT UNDER 22
	222	+	PARAGRAPH (1) OF THIS SUBSECTION WOULD RESULT IN HEAL TH SAVINGS 23
	223	+	ACCOUNT INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE 24
	224	+	REQUIREMENT SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED 25
	225	+	HIGH–DEDUCTIBLE HEALTH PLANS WITH RE SPECT TO THE DEDUCTI BLE OF THE 26
	226	+	PLAN AFTER THE BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 27
	227	+	OF THE INTERNAL REVENUE CODE DOES NOT APPLY WITH RESPECT TO THE 28
	228	+	DEDUCTIBLE REQUIREME NT OF A HIGH –DEDUCTIBLE HEALTH PL AN IF AN 29
	229	+	ENROLLEE IS COVERED UNDER A HIGH –DEDUCTIBLE HEALTH PL AN UNDER 26 30
	230	+	U.S.C. § 223. 31
226	231
227		-	(III) A HEALTH MAINTENANCE ORGANIZATION ; AND 26
228		-
229		-	(IV) ANY OTHER PERSON THA T PROVIDES HEALTH BE NEFIT 27
230		-	PLANS SUBJECT TO REG ULATION BY THE STATE. 28
231		-
232		-	(II) “CARRIER” INCLUDES: 29
233		-
234		-	1. A HEALTH INSURANCE C OMPANY; 30
235		-	6 SENATE BILL 773
	232	+	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 32
	233	+	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 33
	234	+	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 34 6 SENATE BILL 773
236	235
237	236
238		-	2. ~~A NONPROFIT HOSPITAL AND MEDICAL SERVICE~~ 1
239		-	~~CORPORATION ; AND~~ 2
	237	+	BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 OF THE 1
	238	+	INTERNAL REVENUE CODE. 2
240	239
241		-	3. A MANAGED CARE ORGAN IZATION. 3
	240	+	(C) A PHARMACY BENEFITS MA NAGER MAY NOT DIRECT LY OR INDIRECTLY 3
	241	+	SET, ALTER, IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN 4
	242	+	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 5
	243	+	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 6
	244	+	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG OR BIOLOGICAL P RODUCT. 7
242	245
243		-	(4) ~~“COST SHARING ” MEANS~~ ANY ~~COPAYMENT~~ , ~~COINSURANCE , 4~~
244		-	~~DEDUCTIBLE~~, OR OTHER ~~SIMILAR CHA RGE REQUIRED OF AN E NROLLEE FOR A 5~~
245		-	~~HEALTH CARE SERVICE~~ COVERED ~~BY A HEALTH BENEFIT PLAN , INCLUDING A 6~~
246		-	PRESCRIPTION DRUG ~~, AND PAID BY OR ON BE HALF OF THE ENROLLEE . 7~~
	246	+	(D) A THIRD PARTY THAT PAY S FINANCIAL ASSISTAN CE IN ANY AMOUNT , OR 8
	247	+	PORTION OF THE AMOUN T, OF ANY APPLICABLE CO ST–SHARING OR OTHER 9
	248	+	OUT–OF–POCKET EXPENSE ON BE HALF OF AN ENROLLEE FOR A COVERED 10
	249	+	PRESCRIPTION DRUG : 11
247	250
248		-	(5) “ENROLLEE” MEANS AN INDIVIDUAL ENTITLED TO PAYMENT FOR 8
249		-	HEALTH CARE SERVICES FROM AN ADMINISTRATO R OR A CARRIER. 9
	251	+	(1) SHALL NOTIFY THE ENR OLLEE WITHIN 7 DAYS OF THE 12
	252	+	ACCEPTANCE OF THE FI NANCIAL ASSISTANCE O F THE TOTAL AMOUNT O F 13
	253	+	ASSISTANCE AVAILABLE AND THE DURATION FOR WHICH IT IS AVAILABL E; AND 14
250	254
251		-	(6) (I) “HEALTH BENEFIT PLAN ” MEANS A POLICY , A CONTRACT, A 10
252		-	CERTIFICATION , OR AN AGREEMENT OFFE RED OR ISSUED BY AN ADMINISTRATOR 11
253		-	OR A CARRIER TO PROV IDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY 12
254		-	OF THE COSTS OF HEAL TH CARE SERVICES . 13
	255	+	(2) MAY NOT CONDITION TH E ASSISTANCE ON ENRO LLMENT IN A 15
	256	+	SPECIFIC HEALTH PLAN OR TYPE OF HEALTH PL AN, EXCEPT AS AUTHORIZED UNDER 16
	257	+	FEDERAL LAW . 17
255	258
256		-	~~(II) “HEALTH~~ ~~BENEFIT PLAN ” DOES NOT INCLUDE A 14~~
257		-	~~SELF–INSURED EMPLOYEE PLA N SUBJECT TO~~ THE ~~FED~~ ~~ERAL EMPLOYEE 15~~
258		-	~~RETIREMENT INCOME ACT OF 1974 (ERISA)~~. 16
	259	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 18
	260	+	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 19
	261	+	after January 1, 2026. 20
259	262
260		-	(7) “HEALTH CARE SERVICE ” MEANS AN ITEM OR A S ERVICE 17
261		-	PROVIDED TO AN INDIV IDUAL FOR THE PURPOS E OF PREVENTING , ALLEVIATING, 18
262		-	CURING, OR HEALING HUMAN ILL NESS, INJURY, OR PHYSICAL DISABILI TY. 19
263		-
264		-	(B) THE ANNUAL LIMITATION ON COST SHARING PROV IDED FOR UNDER 42 20
265		-	U.S.C. § 18022(C)(1) SHALL APPLY TO ALL H EALTH CARE SERVICES COVERED 21
266		-	UNDER A HEALTH BENEF IT PLAN OFFERED OR I SSUED BY AN ADMINISTRATOR OR A 22
267		-	CARRIER IN THE STATE. 23
268		-
269		-	(C) (1) SUBJECT TO PARAGRAPHS (2) AND (3) PARAGRAPH (2) OF THIS 24
270		-	SUBSECTION, WHEN CALCULATING AN ENROLLEE’S CONTRIBUTION TO AN 25
271		-	APPLICABLE COST SHAR ING REQUIREMENT , AN ADMINISTRATOR OR A CARRIER 26
272		-	SHALL INCLUDE COST SHARING AMOUNTS PAID BY THE ENROLLEE OR O N BEHALF 27
273		-	OF THE ENROLLEE BY A NOTHER PERSON . 28
274		-
275		-	(2) IF THE APPLICATION OF THE THE REQUIREMENT UNDER 29
276		-	PARAGRAPH (1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS 30
277		-	ACCOUNT INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE 31
278		-	REQUIREMENT SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED 32
279		-	HIGH–DEDUCTIBLE HEALTH PLANS WITH RE SPECT TO THE DEDUCTI BLE OF THE 33
280		-	PLAN AFTER THE ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF 34
281		-	THE INTERNAL REVENUE CODE DOES NOT APPLY WITH RESPECT TO THE 35 SENATE BILL 773 7
	263	+	SECTION 3. AND BE IT F URTHER ENACTED, That this Act shall take effect 21
	264	+	January 1, 2026. 22
282	265
283	266
284		-	DEDUCTIBLE REQUIREME NT OF A HIGH –DEDUCTIBLE HEALTH PL AN IF AN 1
285		-	ENROLLEE IS COVERED UNDER A HIGH –DEDUCTIBLE HEALTH PL AN UNDER 26 2
286		-	U.S.C. § 223. 3
287		-
288		-	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 4
289		-	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 5
290		-	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 6
291		-	ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF THE INTERNAL 7
292		-	REVENUE CODE. 8
293		-
294		-	(D) AN ADMINISTRATOR OR A CARRIER MAY NOT DIRE CTLY OR INDIRECTLY 9
295		-	SET, ALTER, IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN 10
296		-	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 11
297		-	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 12
298		-	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG OR BIOLOGICAL PR ODUCT. 13
299		-
300		-	(E) A THIRD PARTY THAT PAY S FINANCIAL ASSISTAN CE IN ANY AMOUNT , OR 14
301		-	PORTION OF THE AMOUN T, OF ANY APPLICABLE CO ST–SHARING OR OTHER 15
302		-	OUT–OF–POCKET EXPENSE ON BE HALF OF AN ENROLLEE FOR A COVERED 16
303		-	PRESCRIPTION DRUG : 17
304		-
305		-	(1) SHALL NOTIFY THE ENROLLEE WITHIN 7 DAYS OF THE 18
306		-	ACCEPTANCE OF THE FI NANCIAL ASSISTANCE O F THE TOTAL AMOUNT O F 19
307		-	ASSISTANCE AVAILABLE AND THE DURATION FOR WHICH IT IS AVAILABL E; AND 20
308		-
309		-	(2) MAY NOT CONDITION TH E ASSISTANCE ON ENRO LLMENT IN A 21
310		-	SPECIFIC HEALTH PLAN OR TYPE OF HEALTH PLAN , EXCEPT AS AUTHORIZED UNDER 22
311		-	FEDERAL LAW . 23
312		-
313		-	(E) (F) THE COMMISSIONER MAY ADOP T REGULATIONS TO CAR RY OUT 24
314		-	THIS SECTION. 25
315		-
316		-	15–1611.3. 26
317		-
318		-	(A) THIS SECTION APPLIES ONLY TO A PHARMACY B ENEFITS MANAGER 27
319		-	THAT PROVIDES PHARMA CY BENEFITS MANAGEME NT SERVICES ON BEHALF O F A 28
320		-	CARRIER. 29
321		-
322		-	(B) (1) SUBJECT TO PARAGRAPHS (2) AND (3) PARAGRAPH (2) OF THIS 30
323		-	SUBSECTION, WHEN CALCULATING A B ENEFICIARY’S CONTRIBUTION TO AN 31
324		-	APPLICABLE COST SHAR ING REQUIREMENT , A PHARMACY BENEFITS MANAGER 32
325		-	SHALL INCLUDE COST S HARING AMOUNTS PAID BY THE B ENEFICIARY OR ON BEH ALF 33
326		-	OF THE BENEFICIARY B Y ANOTHER PERSON . 34
327		-	8 SENATE BILL 773
328	267
329	268
330		-	(2) IF THE APPLICATION OF THE THE REQUIREMENT UNDER 1
331		-	PARAGRAPH (1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS 2
332		-	ACCOUNT INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE 3
333		-	REQUIREMENT SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED 4
334		-	HIGH–DEDUCTIBLE HEALTH PLANS WITH RE SPECT TO THE DEDUCTI BLE OF THE 5
335		-	PLAN AFTER THE BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 6
336		-	OF THE INTERNAL REVENUE CODE DOES NOT APPLY WITH RESPECT T O THE 7
337		-	DEDUCTIBLE REQUIREME NT OF A HIGH –DEDUCTIBLE HEALTH PL AN IF AN 8
338		-	ENROLLEE IS COVERED UNDER A HIGH –DEDUCTIBLE HEALTH PL AN UNDER 26 9
339		-	U.S.C. § 223. 10
340		-
341		-	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 11
342		-	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 12
343		-	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 13
344		-	BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 OF THE 14
345		-	INTERNAL REVENUE CODE. 15
346		-
347		-	(C) A PHARMACY BENEFITS MA NAGER MAY NOT DIRECT LY OR INDIRECTLY 16
348		-	SET, ALTER, IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN 17
349		-	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 18
350		-	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 19
351		-	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG OR BIOLOGICAL PRODUCT . 20
352		-
353		-	(D) A THIRD PARTY THAT PAY S FINANCIAL ASSISTAN CE IN ANY AMOUNT , OR 21
354		-	PORTION OF THE AMOUN T, OF ANY APPLICABLE CO ST–SHARING OR OTHER 22
355		-	OUT–OF–POCKET EXPENSE ON BE HALF OF AN ENROLLEE FOR A COVERED 23
356		-	PRESCRIPTION DRUG : 24
357		-
358		-	(1) SHALL NOTIFY THE ENROLLEE WITHIN 7 DAYS OF THE 25
359		-	ACCEPTANCE OF THE FI NANCIAL ASSISTANCE O F THE TOTAL AMOUNT O F 26
360		-	ASSISTANCE AVAILABLE AND THE DURATION FOR WHICH IT IS AVAILABL E; AND 27
361		-
362		-	(2) MAY NOT CONDITION TH E ASSISTANCE ON ENRO LLMENT IN A 28
363		-	SPECIFIC HEALTH PLAN OR TYPE OF HEAL TH PLAN, EXCEPT AS AUTHORIZED UNDER 29
364		-	FEDERAL LAW . 30
365		-
366		-	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 31
367		-	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 32
368		-	after January 1, 2026. 33
369		-
370		-	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 34
371		-	January 1, 2026. It shall remain effective for a period of 3 years and 6 months and, at the 35
372		-	end of July 1, 2029, this Act, with no further action required by the General Assembly, shall 36
373		-	be abrogated and of no further force and effect. 37
	269	+	Approved:
	270	+	________________________________________________________________________________
	271	+	Governor.
	272	+	________________________________________________________________________________
	273	+	President of the Senate.
	274	+	________________________________________________________________________________
	275	+	Speaker of the House of Delegates.