S 51 COST-SHARING CONTRIBUTIONS FOR PRESCRIPTIONS

Sen Elizabeth "Liz" Stefanics

Actions: SPREF [1] SHPAC/STBTC-SHPAC [10] DP-STBTC [12] DNP-CS/DP - ref SFC-SFC [16] DP [17] fl/a- PASSED/S (37-2) [18] HHHC-HHHC- DP/a [19] PASSED/H (45-21) [23] s/cncrd

Scheduled: Not Scheduled

 Senate Bill 51 (SB 51) requires that insurers credit the insured all discounts or payments made by third parties when calculating cost-sharing obligation
 

 Senate Bill 51 (SB 51) requires that insurers credit the insured all discounts or payments made by third parties when calculating cost-sharing obligation. Cost-sharing means copayment, coinsurance, deductible, out-of-pocket maximum amounts, etc.

The effective date of SB 51 is January 1, 2024.
 

 Prescription drug insurers can continue to charge its insured without discounting cost-share obligation. 

 03/14/2023 Senate Floor amendment 1 (SFla)

SFla requires reductions in prescription drug prices offered by manufacturers to be provided to all customers for the plan or calendar year whichever is longer. Reductions include discounts, rebates, or coupons.
 

 03/08/2023 Senate Tax, Business, and Transportation Committee substitute for Senate Bill 51 (SB 51 STBTCcs)

SB 51 STBTCcs requires that insurers credit the insured all discount, rebates, or payments made by third parties when calculating cost-sharing obligations. Cost-sharing means copayment, coinsurance, deductible, out-of-pocket maximum amounts, and other financial obligation except premiums. 

Beginning in 2024, the bill prohibits insurers from charging a different cost-sharing amount for prescriptions from non-affiliated pharmacies or if administrated at different infusion sites. The bill limits the amount an insured pays at the point of sale for a covered prescription. If a prescription drug rebate reduces the insurer’s copayment to less than zero, the remainder will be credited to the insurer. Plan administrators and pharmacy benefits managers are required to disclose the option to contract for drug cost-sharing protections. 

SB 51 STBTCcs does not apply to Excepted benefit plans (not subject to federal Affordable Care Act and are usually supplemental plans), catastrophic plans (coverage in emergencies and some preventative care with very high deductibles), or tax favored health plans (health savings accounts).