HB79--COST-SHARINGUNDERHEALTHBENEFITPLANS
SPONSOR: Hruza
Thisbillprovidesthatwhencalculatinganenrollee'soverall
contributiontoanout-of-pocketmaximumoranycost-sharing
requirementunderahealthbenefitplan,ahealthcarrieror
pharmacybenefitsmanagermustincludeanyamountspaidbythe
enrolleeorpaidonbehalfoftheenrolleeformedicationwherea
genericsubstituteisnotavailable.
Thebilladditionallyprohibitsahealthcarrierorpharmacy
benefitmanagerfromvaryinganenrollee'sout-of-pocketmaximumor
anyothercost-sharingrequirement,aswellasdesigningbenefits
inamannerthattakesintoaccountof,theavailabilityofany
cost-sharingassistanceprogramforanymedicationwhereageneric
substituteisnotavailable.
Theprovisionsofthisbillappliestohealthbenefitplansentered
into,amended,extended,orrenewedonorafterAugust28,2025.
ThisbillissimilartoHB1628(2024).